Patient: Present this certificate to the pharmacist with your prescription for an instant rebate of up to $30 for Nexa® Plus, Nexa® Select Rx Prenatal Vitamin with Plant-Based DHA, or PreNexa® Rx Prenatal Vitamin with Plant-Based DHA and up to $10 for B-Nexa®. Limit 1 savings offer per purchase for up to 9 purchases of Nexa® Plus, Nexa® Select, or PreNexa® and up to 3 purchases of B-Nexa®. Any cost above the rebate amount will be your responsibility.
Pharmacist: Please dispense Nexa® Plus, Nexa® Select, or PreNexa® at up to $30 off and B-Nexa® at up to $10 off the customer’s out-of-pocket expense. This claim may be submitted electronically through RESTAT using the information on the front of the card. Submit all claims in NCPDP standard 5.1. Secondary processing should follow NCPDP standards for co-pay–only billing (other coverage code 8) or, in some cases, use coordination of benefits processing, dependent on your pharmacy’s software requirements. You will be reimbursed a fee of $2.50 plus the discount offered to the customer directly from RESTAT. Pharmacy or customer mail-in claims may be sent to RESTAT, 11900 W Lake Park Drive, Milwaukee, WI 53224 for prompt reimbursement. All mail-in claims should include a duplicate pharmacy label or receipt (no cash register receipts) along with a copy of the front of the customer savings card. Remember to restore patient profile to primary PBM after claim submission. Call the RESTAT help desk at 1-866-450-3277 for processing questions.
This coupon is not valid for prescriptions reimbursed under Medicare, Medicaid, or any other federal or state program, or where prohibited by law. Where third-party reimbursement covers a portion of your prescription, this coupon is valid only for the amount of your actual out-of-pocket expenses up to a maximum of $30 for Nexa® Plus, Nexa® Select, or PreNexa® and up to a maximum of $10 for B-Nexa®. Offer valid only for prescriptions filled in the United States. Upsher-Smith Laboratories reserves the right to discontinue this offer at any time. It is a violation of federal law to buy, sell, or counterfeit this certificate. Void where prohibited.
© 2012 Upsher-Smith Laboratories, Inc. 105134.06
Nexa® Plus Full Prescribing Information
Nexa® Plus Capsules - Rx only
Rx Prenatal Vitamin with Plant-Based DHA from Algal Oil
- 1.25 mg Folic Acid and 350 mg DHA (key omega-3 fatty acid)
- Essential vitamins and minerals
- Gentle stool softener
DESCRIPTION: Nexa® Plus Capsules are a prescription prenatal/postnatal multivitamin/mineral softgel capsule with plant-based DHA. Nexa® Plus Capsules are available as opaque brown, oblong capsules imprinted “0374” and are available in 30-count bottles (NDC 0245-0374-30).
Each softgel capsule contains:
| Vitamin C (ascorbic acid, USP) | 28 mg |
| Vitamin D3 (cholecalciferol, USP) | 800 IU |
| Vitamin E (d-alpha tocopherol, USP) | 30 IU |
| Vitamin B6 (pyridoxine hydrochloride, USP) | 25 mg |
| Folic Acid, USP | 1.25 mg |
| Biotin | 250 mcg |
| Calcium | 160 mg* |
| Iron (ferrous fumarate, USP) | 29 mg |
| Algal oil blend (derived from Crypthecodinium cohnii) | 660 mg** |
| Docusate Calcium, USP | 55 mg |
* 158 mg calcium from calcium carbonate, USP and 2 mg calcium from docusate calcium, USP
** Providing 350 mg DHA (docosahexaenoic acid)
Other Ingredients: Ascorbyl palmitate, corn oil, ethyl vanillin, FD&C Yellow #6, FD&C Red #40, FD&C Blue #1, gelatin, glycerin, lecithin, soybean oil, sunflower oil, titanium dioxide, water, yellow beeswax, white ink (ammonium hydroxide, isopropyl alcohol, n-butyl alcohol, propylene glycol, shellac glaze in SD-45 alcohol, simethicone, titanium dioxide).
Contains: Soy
INDICATIONS: Nexa® Plus Capsules are indicated to provide vitamin/mineral and plant-based DHA supplementation throughout pregnancy, during the postnatal period for both lactating and non-lactating mothers, and throughout the childbearing years. Nexa® Plus may be useful in improving the nutritional status of women prior to conception.
CONTRAINDICATIONS: Nexa® Plus Capsules are contraindicated in patients with a known hypersensitivity to any of the ingredients. Do not take this product if you are presently taking mineral oil, unless directed by a doctor.
WARNING: Ingestion of more than 3 grams of omega-3 fatty acids (such as DHA) per day has been shown to have potential antithrombotic effects, including an increased bleeding time and International Normalized Ratio (INR). Administration of omega-3 fatty acids should be avoided in patients taking anticoagulants and in those known to have an inherited or acquired predisposition to bleeding.
PRECAUTION: Folic acid alone is improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where vitamin B12 is deficient. Folic acid in doses above 1 mg daily may obscure pernicious anemia in that hematologic remission can occur while neurological manifestations progress.
ADVERSE REACTIONS: Allergic sensitization has been reported following both oral and parenteral administration of folic acid.
CAUTION: Exercise caution to ensure that the prescribed dosage of DHA does not exceed 1 gram (1000 mg) per day.
DOSAGE AND ADMINISTRATION: Before, during and/or after pregnancy, one softgel capsule daily or as directed by a physician.
HOW SUPPLIED: Nexa® Plus Capsules are available as opaque brown, oblong capsules imprinted “0374” and are available in 30-count bottles (NDC 0245-0374-30).
KEEP THIS AND ALL DRUGS OUT OF THE REACH OF CHILDREN.
You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects to Upsher-Smith Laboratories, Inc. at 1-888-650-3789.
Store at 20° - 25°C (68° - 77°F). [See USP Controlled Room Temperature.]
Distributed by:
UPSHER-SMITH LABORATORIES, INC.
Minneapolis, MN 55447
106431-01 Revised 0312
1-800-654-2299 www.upsher-smith.com
© 2012 Upsher-Smith Laboratories, Inc.
All rights reserved.
US Patents 5,407,957; 5,492,938
Nexa® Select Full Prescribing Information
Nexa® Select capsules - Rx only
Rx Prenatal Vitamin with Crypthecodinium cohnii algal oil providing plant-based DHA
- 1.25 mg Folic Acid and 337.5 mg DHA (key omega-3 fatty acid)
- Essential vitamins and minerals
- Gentle stool softener
DESCRIPTION: Nexa® Select capsules are a prescription prenatal/postnatal multivitamin/mineral softgel capsule with C. cohnii algal oil providing plant-based DHA. Nexa® Select capsules are available as opaque brown, oblong capsules imprinted "0245" and are available in 30-count bottles (NDC 0245-0245-30).
Each softgel capsule contains:
| Vitamin C (ascorbic acid, USP) | 28 mg |
| Vitamin E (d-alpha tocopherol, USP) | 30 IU |
| Vitamin B6 (pyridoxine hydrochloride, USP) | 28 mg |
| Folic Acid, USP | 1.25 mg |
| Calcium (tribasic calcium phosphate, NF) | 160 mg |
| Iron (ferrous fumarate, USP) | 29 mg |
| Vitamin D3 (cholecalciferol, USP) | 800 IU |
| Algal oil blend (derived from Crypthecodinium cohnii) | 750 mg* |
| Docusate Sodium, USP | 55 mg |
* Providing 337.5 mg DHA (docosahexaenoic acid)
Inactive Ingredients: Ascorbyl palmitate, ethyl vanillin, FD&C Blue #1, FD&C Red #40, FD&C Yellow #6, gelatin, glycerine, lecithin, medium chain triglycerides, sodium benzoate, soybean oil, sunflower oil, titanium dioxide, tocopherols, yellow beeswax, white ink (ammonium hydroxide, isopropyl alcohol, n-butyl alcohol, propylene glycol, shellac glaze in SD-45 alcohol, simethicone, titanium dioxide).
Contains: Soy
INDICATIONS: Nexa® Select capsules are indicated to provide vitamin/mineral and C. cohnii algal oil providing plant-based DHA supplementation throughout pregnancy, during the postnatal period for both lactating and non-lactating mothers, and throughout the childbearing years. Nexa® Select may be useful in improving the nutritional status of women prior to conception.
CONTRAINDICATIONS: Nexa® Select capsules are contraindicated in patients with a known hypersensitivity to any of the ingredients. Do not take this product if you are presently taking mineral oil, unless directed by a doctor.
WARNING: Ingestion of more than 3 grams of omega-3 fatty acids (such as DHA) per day has been shown to have potential antithrombotic effects, including an increased bleeding time and International Normalized Ratio (INR). Administration of omega-3 fatty acids should be avoided in patients taking anticoagulants and in those known to have an inherited or acquired predisposition to bleeding.
PRECAUTION: Folic acid alone is improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where vitamin B12 is deficient. Folic acid in doses above 1 mg daily may obscure pernicious anemia in that hematologic remission can occur while neurological manifestations progress.
ADVERSE REACTIONS: Allergic sensitization has been reported following both oral and parenteral administration of folic acid.
CAUTION: Exercise caution to ensure that the prescribed dosage of DHA does not exceed 1 gram (1000 mg) per day.
DOSAGE AND ADMINISTRATION: Before, during and/or after pregnancy, one softgel capsule daily or as directed by a physician.
HOW SUPPLIED: Nexa® Select capsules are available as opaque brown, oblong capsules imprinted "0245" and are available in 30-count bottles (NDC 0245-0245-30).
KEEP THIS AND ALL DRUGS OUT OF THE REACH OF CHILDREN.
You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects to Upsher-Smith Laboratories, Inc. at 1-855-899-9180.
Store at 20-25°C (68-77°F). [See USP Controlled Room Temperature.]
Distributed by:
UPSHER-SMITH LABORATORIES, INC.
Maple Grove, MN 55369
MADE IN CANADA
1-800-654-2299 www.upsher-smith.com
US Patents 5,407,957; 5,492,938. Other US Patents Pending.
© 2012 Upsher-Smith Laboratories, Inc.
106948-01 Revised 0812
PreNexa® Full Prescribing Information
PreNexa® Capsules - Rx only
Rx Prenatal Vitamin with Plant-Based DHA from Algal Oil
- 1.25 mg Folic Acid and 300 mg DHA (key omega-3 fatty acid)
- Essential vitamins and minerals
- Gentle stool softener
DESCRIPTION: PreNexa® Capsules are a prescription prenatal/postnatal multivitamin/mineral softgel capsule with plant-based DHA. Each softgel capsule is brown in color, opaque, and imprinted with "PreNexa".
Each softgel capsule contains:
| Vitamin C (ascorbic acid, USP) | 28 mg |
| Calcium (tribasic calcium phosphate, NF) | 160 mg |
| Iron (ferrous fumarate, USP) | 27 mg |
| Vitamin D3 (cholecalciferol, USP) | 400 IU |
| Vitamin E (d-alpha tocopherol, USP) | 30 IU |
| Vitamin B6 (pyridoxine hydrochloride, USP) | 25 mg |
| Folic Acid, USP | 1.25 mg |
| Algal oil (derived from Crypthecodinium cohnii) | 750 mg* |
| Docusate Sodium, USP | 55 mg |
* Providing 300 mg DHA (docosahexaenoic acid)
Inactive Ingredients: Ethyl vanillin, FD&C blue #1, FD&C red #40, FD&C yellow #6, gelatin, glycerin, lecithin, palm kernel oil, sodium benzoate, soybean oil, sunflower oil, titanium dioxide, yellow beeswax, water and white ink (ammonium hydroxide, isopropyl alcohol, n-butyl alcohol, propylene glycol, shellac glaze in SD-45 alcohol, simethicone, titanium dioxide).
Contains: Soy
INDICATIONS: PreNexa® Capsules are indicated to provide vitamin/mineral and plant-based DHA supplementation throughout pregnancy, during the postnatal period for both lactating and non-lactating mothers, and throughout the childbearing years. PreNexa® may be useful in improving the nutritional status of women prior to conception.
CONTRAINDICATIONS: PreNexa® Capsules are contraindicated in patients with a known hypersensitivity to any of the ingredients. Do not take this product if you are presently taking mineral oil, unless directed by a doctor.
WARNING: Ingestion of more than 3 grams of omega-3 fatty acids (such as DHA) per day has been shown to have potential antithrombotic effects, including an increased bleeding time and International Normalized Ratio (INR). Administration of omega-3 fatty acids should be avoided in patients taking anticoagulants and in those known to have an inherited or acquired predisposition to bleeding.
PRECAUTION: Folic acid alone is improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where vitamin B12 is deficient. Folic acid in doses above 1 mg daily may obscure pernicious anemia in that hematologic remission can occur while neurological manifestations progress.
ADVERSE REACTIONS: Allergic sensitization has been reported following both oral and parenteral administration of folic acid.
CAUTION: Exercise caution to ensure that the prescribed dosage of DHA does not exceed 1 gram (1000 mg) per day.
DOSAGE AND ADMINISTRATION: Before, during and/or after pregnancy, one softgel capsule daily or as directed by a physician.
HOW SUPPLIED: Bottles of 30 softgel capsules (NDC 0245-0178-30).
KEEP THIS AND ALL DRUGS OUT OF THE REACH OF CHILDREN.
You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects to Upsher-Smith Laboratories, Inc. at 1-888-650-3789.
Store at 20-25°C (68-77°F). [See USP Controlled Room Temperature.]
Distributed by:
UPSHER-SMITH LABORATORIES, INC.
Minneapolis, MN 55447
MADE IN CANADA
1-800-654-2299 www.upsher-smith.com
US Patents 5,407,957; 5,492,938. Other US Patents Pending.
103115-05 Revised 0811
B-Nexa® Full Prescribing Information
B-Nexa® Tablets - Rx only
DESCRIPTION: B-Nexa® Tablets are a prescription prenatal vitamin that provide B-vitamin nutrition and are formulated with vitamin B6 and ginger to help calm nausea and vomiting of pregnancy (NVP). B-Nexa® Tablets contain 100 mg ginger root powder extract that, when standardized to gingerols, is equivalent to 500 mg ginger root powder. Each caplet shaped tablet is engraved “US” on one side and “215” on the other with a pink film coat.
Each pink tablet contains:
| Vitamin B6 (pyridoxine hydrochloride, USP) | 42 mg |
| Folic Acid, USP | 1.22 mg |
| Calcium (as dicalcium phosphate and tricalcium phosphate) | 124.23 mg |
| Ginger (zingiber officinale) root powder extract | 100 mg |
Other Ingredients: microcrystalline cellulose, maltodextrin, talc, corn starch, croscarmellose sodium, stearic acid, hypromellose, hydroxypropyl cellulose, magnesium stearate, silicon dioxide, titanium dioxide, iron oxide red, iron oxide yellow, iron oxide black.
INDICATIONS: B-Nexa® Tablets are indicated to provide B-vitamin supplementation, with ginger to help calm pregnancy related nausea and vomiting (morning sickness), and may be used in conjunction with a physician prescribed prenatal regimen.
CONTRAINDICATIONS: This product is contraindicated in patients with a known hypersensitivity to any of the ingredients.
PRECAUTIONS: Folic acid alone is improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where vitamin B12 is deficient. Folic acid in doses above 1 mg daily may obscure pernicious anemia in that hematologic remission can occur while neurological manifestations progress.
Concomitant use of ginger in patients with bleeding disorders, or who are on anti-coagulant or anti-platelet therapy, may increase the risk of bleeding.
ADVERSE REACTIONS: Allergic sensitization has been reported following both oral and parenteral administration of folic acid.
DOSAGE AND ADMINISTRATION: One or two tablets daily, in divided doses, or as directed by a physician.
HOW SUPPLIED: Bottles of 60 tablets (NDC 0245-0215-60).
KEEP THIS AND ALL DRUGS OUT OF THE REACH OF CHILDREN.
DO NOT CHEW
Store at controlled room temperature, 15-30°C (59-86°F). Protect from light and moisture.
Distributed by:
UPSHER-SMITH LABORATORIES, INC.
6701 Evenstad Drive
Maple Grove, MN 55369
1-800-654-2299 www.upsher-smith.com
106199-01 Revised 0112