Save on Vagifem® 10 mcg!

At Novo Nordisk, we care about the issues affecting you and your loved ones. This goes beyond just treatment. We offer tips, tools, valuable information—even savings. Because we want to make your life a little easier.

Complete the information below, then click "I agree" to print your Vagifem® 10 mcg Instant Savings Card, brought to you by Novo Nordisk. With this card, eligible patients* will pay a maximum of $10 for each of their next 6 prescriptions on Vagifem® 10 mcg with total savings of up to $60!

Present your Vagifem® 10 mcg Instant Savings Card to your pharmacist to receive this savings.

* Please see Disclaimer and Eligibility Requirements below.

Please provide the information requested below to start saving today.

1. Are you 18 or older? YES NO

2. Are you a resident of the United States? YES NO

3. What state do you reside in?

4. Are you enrolled in any government, state, or federally funded medical or prescription benefit programs? This includes Medicare, Medicaid, Medigap, VA, DOD, and TriCare, as well as any other state or federal employee benefit programs. YES NO

5. Your card is not valid for prescriptions purchased under Medicaid, Medicare, or similar federal, state, or other government-funded benefit programs. Should you begin receiving prescription benefits from such a federal, state, or government-funded program at any time, you will no longer be eligible to participate in this program. We may contact you by phone or mail periodically in order to verify that your eligibility for the program has not changed. Do you acknowledge your agreement with this statement? YES NO

First name		Last name
Address 1		Address 2
City		State
Phone	Please type in a valid phone. Example: 123-456-7890.	ZIP	Please type in a valid zip.
E-mail	Please type in a valid email address. Example: name@email.com.
Verify E-mail address	*
Birth date	You are not eligible to participate in this program because you are not 18 years or older. Thank you for your interest.

How did you learn about this offer?

Questionnaire

1. Please check the most commonly recognized symptoms that you are currently experiencing:
Vaginal dryness
Dyspareunia (painful intercourse)
Vaginal and/or vulvar irritation/itching
Vaginal soreness
Dysuria (painful urination)
Vaginal bleeding associated with intercourse

2. Have you ever tried an over-the-counter product to relieve symptoms of vaginal atrophy?
YesNo

3. Have you ever taken, or are you currently taking, a prescription local vaginal estrogen therapy?
YesNo

Disclaimer and Eligibility Requirements

I agree that the information I am providing may be used by Novo Nordisk, its affiliates or vendors to keep me informed about new products, services, special offers, or other opportunities that may be of interest to me, as they become available. THESE COMMUNICATIONS MAY CONTAIN MATERIAL MARKETING OR ADVERTISING NOVO NORDISK PRODUCTS, GOODS, OR SERVICES. Novo Nordisk will take appropriate measures to protect my information. I can stop Novo Nordisk from sending me future communications by calling 1-877-744-2579, sending a brief note with my name and address to Novo Nordisk at 100 College Road West, Princeton, New Jersey 08540, or by clicking on the "unsubscribe" link, which will be available in future email communications.

By providing my information to Novo Nordisk and acknowledging below, I certify that I am at least eighteen (18) years of age. I also understand that certain information pertaining to my use of the card will be shared by my pharmacy with Novo Nordisk, the sponsor of the card. The information disclosed will include the date that I filled the prescription, the number of pills dispensed by my pharmacist, and the amount, if any, that I will be reimbursed by Novo Nordisk under the Novo Nordisk savings card. This information will be available to Novo Nordisk and third parties working on behalf of Novo Nordisk and will not be shared with anyone else. To take advantage of this program, you must not reside in the state of Massachusetts and not be enrolled in any government, state, or federally funded medical or prescription benefit program. These would include Medicare, Medicaid, VA, DOD, and Tricare. This offer is void in MA and where taxed, restricted, or prohibited by law.

I agree

Vagifem® Indications and Usage

Vagifem® is used after menopause to treat menopausal changes in and around the vagina.

Vagifem® Important Safety Information

What is the most important information I should know about VAGIFEM® (an estrogen hormone)

Using estrogen-alone may increase your chance of getting cancer of the uterus (womb)

Report any unusual vaginal bleeding right away while you are using Vagifem®. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check any unusual vaginal bleeding to find the cause.
Do not use estrogen-alone to prevent heart disease, heart attacks, strokes or dementia (decline of brain function)
Using estrogen-alone may increase your chances of getting strokes or blood clots

Using estrogen-alone may increase your chance of getting dementia, based on a study of women age 65 years or older
Do not use estrogens with progestins to prevent heart disease, heart attack, or dementia
Using estrogens with progestins may increase your chances of getting heart attacks, strokes, breast cancer, or blood clots
Using estrogens with progestin may increase your chance of getting dementia, based on a study of women 65 years and older
You and your healthcare provider should talk regularly about whether you still need treatment with Vagifem®

Do not start using Vagifem® if you currently have or have had certain cancers. Estrogens may increase the chances of getting certain types of cancers, including cancer of the breast or uterus. Also, do not start using Vagifem® if you have unusual vaginal bleeding, had a stroke or heart attack, currently have or have had blood clots, currently have or have had liver problems, have been diagnosed with a bleeding disorder, are allergic to Vagifem® or any of its ingredients, or think you may be pregnant.

Vagifem® is only used in the vagina; however, the risks associated with oral estrogens should be taken into account.

The most commonly reported side effects of Vagifem® included: headache, breast pain, irregular vaginal bleeding or spotting, stomach/abdominal cramps, bloating, nausea and vomiting, hair loss, fluid retention, and vaginal yeast infection.

Estrogens should be used at the lowest possible dose for your treatment only as long as needed.

Please click here for Prescribing Information and FDA-Approved Patient Labeling.

Vagifem® is only available by prescription. For more information about Vagifem®, please call 1-866-668-6336.
Novo Nordisk provides patient assistance for those who qualify. Please call 1-866-310-7549 to learn more about Novo Nordisk assistance programs.
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.

PREMARIN® (Vaginal Cream) and ESTRING are registered trademarks of Pfizer Pharmaceuticals, Inc.
ESTRACE® (Vaginal Cream) is a registered trademark of Warner Chilcott (US), LLC
Vagifem® is a registered trademark of Novo Nordisk FemCare AG. © 2011 Novo Nordisk. All rights reserved. 0711-00004023-1 October 2011