Our pharmacy agrees to abide by the terms and conditions of the Lundbeck Pharmacy Program as detailed below:

1. Stock Holding of Brintellix® 10mg: One pack of the 10mg strength of Brintellix® is to be kept in stock at all times.
2. Maximum price to patients: As part of the criteria for being a Brintellix Patient Program Pharmacy, patients on presentation of a prescription will pay no more than:
   - Brintellix 5mg - maximum price to patient is $64.95
   - Brintellix 10mg - maximum price to patient is $64.95
   - Brintellix 15mg - maximum price to patient is $74.95
   -  Brintellix 20mg - maximum price to patient is $84.95              
3. Service payment: A combined dispensing and service fee of $15.00 (for the 5mg and 10mg) and $20 (for the 15mg and 20mg) is paid monthly, following submission of a completed Pharmacy eForm.