*Subject to eligibility. See Rules and Regulations below.

JALYN Savings Card

Save up to $15 on your prescriptions for JALYN with the JALYN Savings Card. Simply print and present this card to your pharmacist each time you pick up your prescription.

Patient is not eligible if prescriptions are paid in part or full by any state or federally funded programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD or TriCare and where prohibited by law. See full rules and regulations below.

Rules and Regulations

TO THE PATIENT:

Present this card to your pharmacist with your prescription for 30 or more JALYN 0.5 mg/0.4 mg Capsules. For each prescription of 30 or more capsules, receive up to $15 off the cost of your copay or pharmacy bill (see front of card for details). Not valid with any other offer. This savings card can be used no more than 12 times for $15 off 30 or more capsules. This card expires March 31, 2012.

Duplicates of this card are invalid. Please see eligibility rules on the back. To aid in processing, please present this card when you DROP OFF your prescription, not when you PICK UP. In order to be eligible for this offer: (a) where third-party reimbursement covers a portion of your prescription, this card is valid only for the amount of your actual out-of-pocket expenses up to a maximum of $15 on each prescription of 30 or more capsules of JALYN; (b) your prescription MUST NOT be covered (ie, reimbursed) by a federal healthcare program, including Medicare or Medicaid, or by any similar federal or state program, including a state pharmaceutical assistance program, and (c) you MUST NOT be Medicare eligible and enrolled in an employer-sponsored health plan/prescription drug benefit program for retirees (ie, you are eligible for Medicare Part D but receive a prescription drug benefit through a former employer).

Mail-Order Processing Instructions:
• Call your mail-order pharmacy first to see if they accept the card. If they do not, please follow these simple steps:
• Call 1-800-657-7613 (on the back of your card).
• Ask for a Direct Member Reimbursement Form to be mailed to you.
• Attach your mail-order pharmacy receipt, sign the form and return.

Further, if you are a resident of Massachusetts or Puerto Rico, this offer is valid only if you are paying the entire cost of the prescription yourself (ie, your insurance does not cover any of the cost of your prescription). Your acceptance of this offer must be consistent with the terms of any drug benefit provided by your health insurer, health plan, or private third-party payor, and you agree to report acceptance of this offer to your health insurer, health plan, or third-party payor as may be required. This offer may not be used with any other discount, coupon, or offer. Only an original savings card will be accepted and must be presented to your pharmacist at the time you have the prescription filled - not valid if reproduced. Offer good only in USA. Not transferable. Void where prohibited by law, taxed, or restricted. Limit 1 use per purchase.

By tendering this savings card, I, the Patient, certify that: (i) I have read the above terms, (ii) I will not submit a claim under any federal, state, or other governmental programs for this prescription, (iii) if I am Medicare eligible, I am not enrolled in an employer-sponsored health plan or prescription drug plan for retirees, and (iv) I will otherwise comply with the terms above. 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.

TO THE PHARMACIST:

McKesson Corporation has been authorized to reimburse you up to $15 for each 30 capsules, plus an administration fee for processing each use of this savings card, when accompanied by a valid prescription for 30 or more JALYN 0.5 mg/ 0.4 mg Capsules. You will be reimbursed up to $15 for each subsequent use of this card, through its expiration date.

• If primary coverage exists, input card information as secondary coverage and transmit using the COB segment of NCPDP transaction.
• Applicable discounts will be displayed in the transaction response.
• Return this card to the patient so that it may be used for additional savings on future prescriptions.

By redeeming this savings card, I certify that: (i) I have received this card from an eligible patient, (ii) I have dispensed the product as indicated, (iii) I have not submitted, and will not submit, a claim for reimbursement to the patient or any federal, state, or other governmental payor, and (iv) I will otherwise comply with the terms hereof. I further certify that my participation in this program is consistent with all applicable state laws and any obligations, contractual or otherwise, that I have as a pharmacy provider. This coupon is subject to terms and conditions established by McKesson Corporation. By accepting this coupon, I agree to the program Terms and Conditions posted at www.mckesson.com/mprs. I also grant McKesson Corporation the right to audit any coupons I have submitted.

Offer valid only for prescriptions filled in the US. GlaxoSmithKline reserves the right to discontinue this offer at any time. It is a violation of federal law to buy, sell, or counterfeit this savings card.