Print Your Z5 Plus Co-Pay Card

Print this page and take it to your pharmacy to start saving right away on Zemplar Capsules.

Z5 co-pay card

Just a reminder, in order to use the Zemplar Z5 Plus Co-Pay Card you must be privately insured for your drug coverage or cash-paying (uninsured). If you are cash-paying (uninsured), we also encourage you to call 1-877-ZEMPLAR (1-877-936-7527), option 2 to see if you may be eligible for other financial assistance options.

If you have Medicare Part D/Medicaid drug coverage, or are a resident of Massachusetts, you are not eligible to use this card. Call 1-877-ZEMPLAR (877-936-5727), Option 2, for more information about other financial assistance programs that may be available to you.

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Next: Enroll in the Zemplar Z5 Plus Program for additional benefits

Zemplar Capsules Safety Facts

Zemplar Capsules are a prescription medication.
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.
If you cannot afford your medication, contact: www.pparx.org or call the toll-free phone number (1-888-4PPA-NOW) for assistance.
You may also call Abbott at 1-877-ZEMPLAR (1-877-936-7527) for more information.

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99974677604

To Patient: Give this card to your pharmacist along with your prescription of Zemplar. Remember to keep this card for future Zemplar prescriptions.
To Pharmacist: The Z5 Plus Card will reduce your customer's co-pay to $5 up to a maximum of $195 for 1 mcg, $390 for 2 mcg, and $780 for 4 mcg. Customer's co-pay and benefit will increase respectively based on each 30-days, supply, up to a 90-days, supply. Return this card to your customer for future use.
For Insured Customers: Process a Coordination of Benefits (COB/split bill) claim using your customer's prescription insurance for the PRIMARY claim. Submit the SECONDARY claim to PDM under BIN #610020.
For Non-Insured Customers: Submit claim for Zemplar to PDM under BIN #610020. Blood Pressure Medications: Eligible patients in the Z5 Plus Program may receive up to a maximum of $20 off of a 30-day supply of one or two blood pressure medications in the following classes: ACE inhibitors, alpha blockers, ARBs, beta-blockers, calcium channel blockers, diuretics, and any fixed-dose combinations of products in these classes. ZEMPLAR Capsules must be processed first. Other covered medications must be filled within 35 days of the date ZEMPLAR Capsules were filled.
Eligibility and Restrictions: This card is not valid for persons eligible for reimbursement of any of these products, in whole or in part, under Medicare Part D, Medicaid, or similar federal or state programs. Offer void in MA and where prohibited by law.
For processing questions call TrialCard at 1-877-858-5451. For questions specific to this program or regarding products covered by this card, call 1-877-ZEMPLAR (1-877-936-7527). Mail claims can be submitted to the Z5 Plus Program, 6501 Weston Parkway, Suite 370, Cary, NC 27513, with a copy of the Zemplar co-pay card and the original pharmacy receipt. No cash register receipts will be accepted.
Abbott reserves the right to amend or discontinue this program at any time.

Use and Important Safety Information

Use¹

ZEMPLAR^® (paricalcitol) Capsules are an active form of vitamin D used to prevent and treat secondary hyperparathyroidism (increased parathyroid hormone levels) in patients with Stage 3 or Stage 4 chronic kidney disease and in Stage 5 patients on dialysis.

To help lower your chance of getting symptoms of high calcium in your blood, your doctor should make sure the level of calcium in your blood is 9.5 mg/dL or lower before starting you on ZEMPLAR Capsules if you have Stage 5 kidney failure and are on dialysis.

Important Safety Information¹

You should not start or continue to take ZEMPLAR Capsules if you have symptoms of high calcium or vitamin D. Taking too much vitamin D or taking it for a long time can cause very high calcium or vitamin D levels which may cause serious health problems and the need for emergency medical care. Signs of high calcium include feeling tired, difficulty thinking clearly, loss of appetite, nausea, vomiting, constipation, increased thirst, increased urination, and weight loss. Tell your doctor if you are having any of these signs.

Before and while taking ZEMPLAR Capsules, tell your doctor about all medications that you are taking, including prescription and nonprescription drugs, aluminum-containing compounds, supplements, and herbal preparations, or any change in your medical condition.

Your doctor should measure your blood levels of PTH, calcium, and phosphorus before starting you on and while you are taking ZEMPLAR Capsules. Your doctor may order the tests more often when you begin ZEMPLAR Capsules or if your dose is changed. Your doctor may adjust your dose based on the results of your blood tests.

It is important that you follow your ZEMPLAR medication plan exactly as your doctor has ordered and follow any instructions you were given about your diet and phosphorus restrictions.

The most common side effects with the use of ZEMPLAR Capsules include diarrhea, nausea, swelling, allergic reaction, viral infection, high blood pressure, vomiting, inflammation of the throat and nose and dizziness.

This is the most important information to know about ZEMPLAR Capsules. For more information, talk with your health care provider.

Reference:

Zemplar^® (paricalcitol) Capsules [package insert]. North Chicago, IL; Abbott Laboratories.