Patient: Present this certificate to the pharmacist with your prescription for an instant rebate of up to $30 for Nexa® Select 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® 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® 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® Select or PreNexa® and up to a maximum of $10 for
© 2012 Upsher-Smith Laboratories, Inc. 105134.03
Nexa® Select Full Prescribing Information
Nexa® Select capsules - Rx only
Rx Prenatal Vitamin with Plant-Based DHA from Algal Oil
- 1.25 mg Folic Acid and 325 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
Each softgel capsule contains:
| Vitamin C (ascorbic acid, USP) | 28 mg |
| Vitamin E (d-alpha tocopherol, USP) | 30 IU |
| Vitamin B6 (pyridoxine hydrochloride, USP) | 25 mg |
| Folic Acid, USP | 1.25 mg |
| Calcium (tricalcium 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 325 mg DHA (docosahexaenoic acid)
Inactive Ingredients: Ascorbyl palmitate, 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, 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 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 “0244” and are available in 30-count bottles (NDC 0245-0244-30).
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.
106100-01 Revised 1111
PreNexa® Full Prescribing Information
PreNexa® Capsules - Rx only
Rx Prenatal Vitamin with Plant-Based DHA
- 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 |
| DHA (docosahexaenoic acid, contained in the oil derived from microalgae) | 300 mg |
| Docusate Sodium, USP | 55 mg |
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 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; 6,977,167. Other US Patents Pending.
103115-03 Revised 0410
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 “214” on the other with a pink film coat.
Each pink tablet contains:
| Vitamin B6 (pyridoxine hydrochloride, USP) | 40 mg |
| Folic Acid, USP | 1.2 mg |
| Calcium (as dicalcium phosphate and tricalcium phosphate) | 124.1 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 0245-0214-60).
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
104472-06
Revised 0911