Program Details. PatientAssistance.com is glad to present this offer finding to you. You will find the program details located through the offer link below. Compare prices, print coupons and get savings tips for Pylera (Bismuth, Metronidazole, and and Tetracycline) and other Duodenal Ulcer drugs at CVS, Walgreens, and other pharmacies. Prices start at $940.98 Pharmacy Clinical Prior Authorization Assistance Chart Effective February 2019. Rev. 02/2019 mco-pcpaac TxVendorDrug.com PAGE 2 OF 7 Feb. 2019 Revisions Eisai Reimbursement resources, your source for reimbursement information related to select Eisai products. Back. The key below explains what each icon means. Scroll down to find all drugs and dosages that can offer savings or information by clicking on the drug name then click on the icon: You may be able to lower your total cost by filling a greater quantity at one time. Trisha Torrey is Every Patient's Advocate. She is a newspaper columnist, radio talk show host, national speaker, and the guide to patient empowerment at About.com. Rabeprazole Prices, Coupons and Patient Assistance Programs. Rabeprazole is a member of the proton pump inhibitors drug class and is commonly used for Barrett's Esophagus, Duodenal Ulcer, Duodenal Ulcer Prophylaxis, and others. Eis ai cannot guarantee payment of any claim. Coding, coverage, and reimbursement may vary significantly by payor, plan, patient, and setting of care. Save money by searching our extensive list of medically related supplies and drug coupons by name or category.