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ACTIVATE SAVINGS CARD

Already have a ULORIC Savings Card?

Register to enroll in GoutSmart and activate your existing ULORIC Savings Card.

Contact Information

Please note that all information is required unless noted as optional.

First Name:

Last Name:

E-mail:

Retype  E-mail:

5-digit ZIP Code:

Please note that this program is open to U.S. residents only.

SAVINGS CARD ACTIVATION

Please enter the 12-digit ID# displayed on the front of your ULORIC Savings Card.

Please tell us a little more about yourself so we can customize your resources

Are you activating the ULORIC Savings Card for yourself or someone else?




 

Approximately how long have you been diagnosed with gout?


 

Approximately how many gout attacks do you suffer from in a year?



 

How would you rate the severity of your attacks?


 

Have you previously used, and stopped using, any of the following to treat your gout? [Check all that apply]



 

Your gender:

 

When were you born?

OPTIONAL: Would you also like to receive information about gout and ULORIC by mail in the future?

If so, please provide your postal address here. (This is optional)

Street Address - Line 1:

Street Address - Line 2:

City:

State:

 

 

Terms and Agreement

By clicking the “Activate” button below, I certify that I am not covered by:

  • Any federal or state healthcare program such as Medicare, Medicaid, Veterans Administration, TriCARE, etc., including state medical or pharmaceutical assistance programs;
  • The Medicare Prescription Drug Program (Part D), or I am not currently covered in the coverage gap;
  • Insurance that is paying the entire cost of the prescription;
  • An insurer or other Third Party Payor in Massachusetts.

Your Privacy

By clicking the “Activate” button below, I understand that I am giving Takeda Pharmaceuticals U.S.A., Inc., its affiliates and business partners, permission to use my personal information to provide me with information and offers related to gout and related treatment options. I understand I may revoke my permission at any time. To learn how Takeda will use and protect your personal information, click here to view our Privacy Policy.


Eligibility Requirements & Terms and Conditions

The use of this card is subject to the Eligibility Requirements and Terms & Conditions. See card for more details. Offer expires March 31, 2013.

Use of ULORIC

ULORIC is a prescription medicine used to lower blood uric acid levels in adults with gout. ULORIC is not for the treatment of high uric acid without a history of gout.

Individual results may vary.

Important Safety Information

Do not take ULORIC if you are taking Azathioprine or Mercaptopurine.

Your gout may flare up when you start taking ULORIC; do not stop taking your ULORIC even if you have a flare. Your healthcare provider may give you other medicines to help prevent your gout flares.

A small number of heart attacks, strokes, and heart-related deaths were seen in clinical studies. It is not certain that ULORIC caused these events.

Tell your healthcare professional about liver or kidney problems or a history of heart disease or stroke.

Your healthcare professional may do blood tests to check your liver function while you are taking ULORIC.

The most common side effects of ULORIC are liver problems, nausea, gout flares, joint pain, and rash.

Please see the complete Prescribing Information and talk to your healthcare professional.

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.

ULORIC is a trademark of Teijin Pharma Limited registered with the U.S. Patent and Trademark Office and used under license by Takeda Pharmaceuticals America, Inc.
©2012 Takeda Pharmaceuticals U.S.A., Inc.

This site is intended for use by US residents only. TXF-01608 03/12

 

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Please click "Continue" if you wish to be taken to this non-Takeda website.