Ther-Rx - Clindesse

How to get your rebate

download printable rebate form

Mail to:
Beechwood Associates, Inc.
PO Box 1190
Morrisville, NC 27560-9914

First Name:____________________________________________________

Last Name:____________________________________________________

City:_______________________State:________________Zip:__________

Email (required)________________________________________________

Phone (required)_______________________________________________

1. How often do you experience bacterial vaginosis (BV)?

This is the first time
Once every 5 years
Once a year
At least 4 times a year

2. What is most important to you in a BV treatment?

Single dose
Easy to use
Anytime dosing
Symptom relief

3. What do you like best about Clindesse?

Single dose
Less mess than other creams
Anytime dosing
Symptom relief

4. How long did it take for you to begin feeling symptom relief?

I did not have symptoms
1 to 12 hours
12 to 24 hours
More than 24 hours

5. Would you use Clindesse again?

Yes
No

6. Where did you hear about Clindesse?

Physician
Nurse
Web site
Patient brochure
Other

7. How did you find out you had BV?

Went to healthcare provider with recurrent symptoms
Went to healthcare provider with unknown vaginal symptoms
Went to healthcare provider for checkup

8. If you have previously used another BV medication, why did you switch to Clindesse?

Healthcare provider recommended it
Other product didn’t work
Other product was messy
Other

Certificate#

Plan#

I hereby certify that I meet the eligibility requirements and wish to participate in this program:

Patient Signature:______________________________________________

Date:________________________________________________________

Eligibility Requirements

In order to be eligible for this offer, you must be responsible for at least $15.00 of the cost of this prescription yourself (if your prescription is not covered by insurance or if your insurance co-pay is at least $15.00). You are not eligible for this offer if all or any part of the cost of your prescription is covered by a federal healthcare program, including Medicare or Medicaid, or by any similar federal or state program, including a state pharmaceutical assistance program. If you are a resident of Massachusetts, this coupon 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 payer, and you must agree to report acceptance of this offer to your health insurer, health plan, or third-party payer as may be required. This offer may not be used with any discount coupon or offer. Only originals of this coupon will be accepted. Offer void where prohibited by law, taxed, or restricted. Offer good only in USA. Ther-Rx reserves the right to rescind, revoke, or amend this offer without notice. Limit 1 per purchase.

Clindesse^® (clindamycin phosphate) Vaginal Cream, 2%, is indicated for the treatment of bacterial vaginosis in non-pregnant women. Clindesse is Pregnancy Category B, which means there are no adequate and well-controlled studies in pregnant women. Therefore, Clindesse should be used during pregnancy only if clearly needed.

Note: For purposes of this indication, a clinical diagnosis of bacterial vaginosis is usually defined by the presence of a homogeneous vaginal discharge that (a) has a pH of greater than 4.5, (b) emits a “fishy” amine odor when mixed with a 10% KOH solution, and (c) contains clue cells on microscopic examination. Gram’s stain results consistent with a diagnosis of bacterial vaginosis include (a) markedly reduced or absent Lactobacillus morphology, (b) predominance of Gardnerella morphotype, and (c) absent or few white blood cells.

Other pathogens commonly associated with vulvovaginitis, e.g., Trichomonas vaginalis, Chlamydia trachomatis, N. gonorrhoeae, Candida albicans, and Herpes simplex virus, should be ruled out.

Important Safety Information

Clindesse is contraindicated in individuals with a history of hypersensitivity to clindamycin, lincomycin, or any of the components of this vaginal cream, and in individuals with a history of regional enteritis, ulcerative colitis, or a history of “antibiotic-associated” colitis.

This cream contains mineral oil that may weaken latex or rubber products such as condoms or vaginal contraceptive diaphragms. Therefore, the use of such barrier contraceptives is not recommended concurrently or for 5 days following treatment with Clindesse. During this time period, condoms may not be reliable for preventing pregnancy or for protecting against transmission of HIV and other sexually transmitted diseases.

Pseudomembranous colitis has been reported with nearly all antibacterial agents, including clindamycin. Orally and parenterally administered clindamycin has been associated with severe colitis. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of Clindesse, even though there is minimal systemic absorption of clindamycin from the vagina with administration of Clindesse Vaginal Cream.

In clinical trials (n=368), 1.6% of patients discontinued therapy due to adverse events. The most frequently reported adverse events were vaginosis fungal (14.1%), vulvovaginal pruritus (3.3%), and headache (2.7%).