Your first prescription is free.*
Then pay no more than $25 for each
of your next 11 refills.

savings card

* Please see eligibility rules. Restrictions may apply.

To take advantage of the Patient Savings Program,
Please enter your information below:

First Name:  
Last Name:  
E-mail:  
Address:
City:  
State:
Zip:
Phone:  
Date of Birth:    
Gender:
You must be 18 or older to participate in the
FORTESTA Gel Patient Savings Program
 
Required information
 
Yes, I would like to receive updates on the Patient Savings
Program
and other relevant information when available.
 
Check One: E-Mail         Mail
 
If you do not wish to receive information, please unselect box.
 
By providing your name, address, and other requested information, you are giving Endo Pharmaceuticals Inc., and other parties working with us, the permission to communicate with you about FORTESTA Gel or other products, services, and offers from Endo Pharmaceuticals Inc. We will not sell your name or other personal information to any other party for its marketing use.
 
Click to print Savings Program Card now
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