01. Edit your xarelto coupon for 12 months free online
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Xarelto rebate form 2026
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02. Sign it in a few clicks
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How to use or fill out xarelto rebate form with our platform
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- Click ‘Get Form’ to open the XARELTO® rebate form in the editor.
- Begin by enrolling in the Janssen CarePath Savings Program if you haven't already. You can activate your card by calling 888-XARELTO or visiting Xarelto.com.
- Fill in your personal information, including your name, gender, date of birth, address, email, state, zip code, and phone number. Ensure all required fields marked with an asterisk are completed.
- Enter your 11-digit Savings Program ID number found on the front of your card.
- Sign and date the form to confirm that you have completed the enrollment and activation process.
- Attach a copy of your pharmacy receipt that includes your name, medication details, date, and amount paid for XARELTO®.
- Mail the signed form along with the pharmacy receipt to the address provided on the next page.
Start using our platform today to easily complete your XARELTO® rebate form for free!
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