Zembrace Platinum Pass

Platinum Pass®
savings card

Pay $0 per prescription,* per month, renewable annually
Eligible commercially insured patients pay $0 per prescription,* regardless of coverage.

Before you visit the pharmacy
You’ll need to activate your Platinum Pass® savings card. Use the form below or call 1-855-699-6062.

Complete form

Enroll or activate your Platinum Pass® savings card for Zembrace® SymTouch®

Fill out the form below to either enroll and download, or activate your savings card.

*All fields required.

Step 1: Let's figure out if you need to enroll or activate. Select which option best describes you.

Step 2: Enter your information

Enter your Platinum Pass® ID Number. You can find your ID Number in the bottom right hand corner of your card.

Are you a resident of the United States, Puerto Rico, Guam or the Virgin Islands?

Do you have Commercial or Private Insurance?

Are your prescriptions paid for in part or full under any state or federally funded programs? Such programs include but are not limited to Medicare or Medicaid, Medigap, VA, TriCare, or DOD.

What is your preferred method of contact?

Information Disclaimer

I understand that the personal information I provide and information pertaining to my use of the savings card at the pharmacy will be shared with Upsher-Smith Laboratories, LLC, and its third-party partners.

I also authorize Upsher-Smith Laboratories, LLC, and its partners to communicate with me about products, health conditions, co-pay and financial assistance. I agree to be contacted by mail, email, and at the phone number I provided to leave voice messages, and interactive voice recordings.

I may opt out of individual communications of the program entirely at any time by calling 1-855-699-6062. Upsher-Smith Laboratories, LLC, and companies providing services to Upsher-Smith Laboratories, LLC, will not sell or rent my personally identifiable information, as described in the Privacy Policy, which I can view by visiting upsher-smith.com.

Once you click agree and submit, you will immediately receive a downloadable Platinum Pass® savings card. Follow the instructions to download and save your card.

Once you click agree and submit, your pass is activated and you can present the card to your pharmacist for instant savings.

Have a question or need support? Please call Access Pathways® Program at 1-855-699-6062.