Request or activate a Savings Card

STEP 1 OF 2: SEE IF YOU QUALIFY FOR AN STRIVERDI RESPIMAT SAVINGS CARD

You may be eligible to pay as little as $35* for a 30-day prescription fill with the STRIVERDI RESPIMAT Savings Card. To get started, fill out the form below. All fields are required unless noted as optional.

I am signing up for savings for:

Required.

Myself

Someone else (must be 18 years or older)

Are you 18 years or older and live in the 50 United States, DC, or Puerto Rico?

Required.

Yes

Does one of the following describe you: I have commercial insurance; I have insurance through my employer; I do not have insurance?

Required.

Yes

Are your prescriptions paid for in part or full by any state or federally funded program such as Medicare or Medicaid, Medigap, Veterans Affairs, Department of Defense, or TRICARE?

Required.

Yes

*Terms and Conditions Apply.

Need some help?

If you'd like assistance enrolling in the STRIVERDI RESPIMAT Savings Card program, or if you have any questions, we're here for you.

Call 1-888-215-8375

Mon-Fri, 8 AM to 8 PM ET

APPROVED USE for STRIVERDI RESPIMAT

Striverdi^® Respimat^® (olodaterol) Inhalation Spray is a prescription medicine used long term, 2 puffs, 1 time each day, in controlling symptoms in adults with chronic obstructive pulmonary disease (COPD). COPD is a chronic lung disease that includes chronic bronchitis, emphysema, or both.

STRIVERDI RESPIMAT is not for treating sudden symptoms of COPD. Always have a rescue medicine with you to treat sudden symptoms.

Striverdi is not for asthma.

IMPORTANT SAFETY INFORMATION for STRIVERDI RESPIMAT

Do not use STRIVERDI if you have asthma. People with asthma who take long‐acting beta₂‐agonist (LABA) medicines, such as STRIVERDI RESPIMAT, without also using a medicine called an inhaled corticosteroid (ICS), have an increased risk of serious problems from asthma, including being hospitalized, needing a tube placed in their airway to help them breathe, or death.

Get emergency medical care if your breathing problems worsen quickly or you use your rescue medicine but it does not relieve your breathing problems. Call your healthcare provider if breathing problems worsen over time while using STRIVERDI.

Do not use STRIVERDI RESPIMAT more often than prescribed for you by your doctor. Do not use STRIVERDI RESPIMAT with other LABAs.

Do not use STRIVERDI for treating sudden breathing problems. Always have a rescue inhaler with you to treat sudden symptoms.

Tell your doctor about all of your medical conditions, including heart problems, high blood pressure, seizures, thyroid problems, and diabetes.

STRIVERDI RESPIMAT can cause serious side effects including sudden shortness of breath that may be life threatening, fast or irregular heartbeat, increased blood pressure, chest pain, tremor, headache, nervousness, high blood sugar, or low blood potassium that may cause muscle weakness or abnormal heart rhythm. If any of these happen, stop taking STRIVERDI and seek immediate medical help.

Call your healthcare provider or get emergency medical care if you get any symptoms of a serious allergic reaction including: rash, hives, itching, swelling of the face, lips, tongue, throat, and difficulties in breathing or swallowing.

The most common side effects are runny nose, sore throat, upper respiratory tract infection, bronchitis, urinary tract infection, cough, dizziness, rash, diarrhea, back pain, and joint pain.

Tell your doctor about all the medicines you take, including prescription and non‐prescription medicines, vitamins, and herbal supplements. STRIVERDI and certain other medicines may affect each other.

STRIVERDI is for oral inhalation only.

The STRIVERDI cartridge is only intended for use with the STRIVERDI RESPIMAT inhaler.

Do not spray STRIVERDI into your eyes.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch, or call 1‐800‐FDA‐1088.

Read the step-by-step patient Instructions for Use for STRIVERDI RESPIMAT before you use your inhaler.

CL-STRR-100001 6.5.2019

Please see full Prescribing Information, Patient Information, and Instructions for Use for STRIVERDI RESPIMAT.