Lialda
Items marked with (*) are required.
*Enter your 11-digit Pharmacy Savings Card numberItems marked with (*) are required.
ELIGIBILITY VERIFICATION
First, we need to verify that you are eligible for the Lialda® Pharmacy Savings Card.
Please fill in the information below.
Items marked with (*) are required.
*Date of birth
*Are you a resident of the United States?
YES NO

*Is your prescription covered, in whole or in part, under any state, federal, or government program, including but not limited to Medicare, Medicaid, Medigap, VA, DOD, or TRICARE?
YES NO