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Valid for: Humalog KwikPen, Humalog KwikPen 75/25, Or Humalog KwikPen 50/50
Patient: Redeem at local retail pharmacy.

Pharmacist: By accepting this offer you certify that you understand and agree to comply with the offer terms set forth herein. Submit claim to Wellpoint NextRx. Processor requires Valid

Prescriber ID#, Patient Name, and Person Code for claim adjudication. For assistance call 1-866-291-1621. Limit: (1) voucher per patient per 12 month period.

THIS OFFER MAY BE TERMINATED, RESCINDED, REVOKED, OR AMENDED BY LILLY USA, LLC AT ANY TIME.

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