Eligible Patients can receive a FREE* CONTOUR® NEXT ONE blood glucose meter
with minimum 50-count CONTOUR® NEXT test strip purchase

Simple to use. Simple to get.

We're committed to helping you simplify your life with diabetes. That is why we made it so simple for you to get your free* CONTOUR® NEXT ONE meter.

All you have to do is:
  • Fill out the information below
  • Click the SUBMIT button
  • Print your coupon and bring it to your local pharmacy with a prescription from your Doctor (or simply have your doctor call in the prescription)
  • Purchase minimum 50-count CONTOUR® NEXT test strip at the pharmacy
  • Get your free* CONTOUR® NEXT ONE meter

*Limitations and restrictions apply. Limit one meter per person. Void where prohibited by law.

This offer is not valid for participants eligible for prescriptions reimbursed under Medicaid, Medicare drug benefit plan, Tricare or other federal or state health programs.

Tell us a little about yourself:

Title *
First Name *
Last Name *
Street Address *
City *
State *
Zip *
Date of birth of meter user *
Phone (Home) *
Email *
Confirm Email *
How do you manage your diabetes?
How often do you test your blood glucose?
How do you control your diabetes?
What meter are you currently using?
What type of healthcare coverage/reimbursement for your strips?
Where do you expect to get your supplies for this meter?
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Thank you for choosing the CONTOUR® NEXT ONE

To get your free* CONTOUR® NEXT ONE blood glucose meter today, just:

  • Take this coupon to your local pharmacy with a prescription from your doctor (or have your doctor call in the prescription)
  • Purchase minimum 50-count CONTOUR®NEXT test strip at the pharmacy
  • Get your free* CONTOUR® NEXT ONE on the spot
Free* CONTOUR® NEXT ONE
RxBIN#:
PCN#:
GROUP#:
ID#:
Offer Expires: Not currently being returned from the service
  • Limit 1 meter per patient per 12 month period for purchase of product indicated.
  • This voucher is valid for 1 fill only, and refills will not be authorized.
  • Please dispense one CONTOUR® NEXT ONE meter at no charge to the patient.
  • This offer cannot be redeemed for cash, or combined with any other offer, coupon, or discount.
  • Transmit claim on-line using RxBIN#: 015251.
  • For assistance in filing this claim contact the Help Desk at 1-800-510-4836
  • This offer must be accompanied by a prescription for a CONTOUR® NEXT ONE meter and minimum 50-count CONTOUR®NEXT test strip purchase. Contact physician if no prescription on file.
  • Processor requires valid Prescriber ID#, Patient Name, and DOB for claim adjudication.
  • Please remove the ID# from the patient profile after claim is processed.
  • Ascensia reserves the right to terminate the program without notice.
  • Offer void where prohibited by law.

These products are provided for evaluation purposes only and may not be charged to any patient and the provider may not submit a claim for reimbursement to Medicare, Medicaid, or other public or private insurer for the sample product.

*Limitations and restrictions apply. Limit one meter per person. Void where prohibited by law.

This offer is not valid for participants eligible for prescriptions reimbursed under Medicaid, Medicare drug benefit plan, Tricare or other federal or state health programs.

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