MTMR Program Overview

My Tears, My Rewards® Program Overview

Support every step of the way matters—You are invited to join the My Tears, My Rewards® (MTMR) Program

The type of Chronic Dry Eye disease that is caused by inflammation and reduces tear production may require continuous prescription treatment. To support and reward your commitment to staying on RESTASIS® (Cyclosporine Ophthalmic Emulsion) 0.05%, Allergan has created
the My Tears, My Rewards® (MTMR) Program.

By joining the MTMR Program, you will qualify for:

  • Continuous rebates that give you the opportunity to reduce costs on RESTASIS® Ophthalmic Emulsion prescriptions*
    • For potential savings of hundreds of dollars a year*
    • Including extra savings on 90-day prescriptions of RESTASIS®*
  • Ongoing information and counseling
    • Regular e-mails and MTMR Program Guide
    • Access to the RESTASIS® Patient Support Center
    • Helping you manage your type of Chronic Dry Eye disease and get the most out of your RESTASIS® Ophthalmic Emulsion treatment
    • Providing you with other information and tips about eye health-related issues

*The actual reimbursement for a member’s out-of-pocket costs for RESTASIS® will vary according to refill quantity, personal healthcare insurance coverage, and adherence to FDA dosing guidelines. Please review the RESTASIS® My Tears, My Rewards® Program guidelines to learn about the savings you may be eligible for.

†MTMR members with 30-day prescriptions may enjoy paying no out-of-pocket expenses up to $75 on every 4th RESTASIS® Ophthalmic Emulsion prescription refill. MTMR members with 90-day prescriptions may enjoy paying no out-of-pocket expenses on RESTASIS® prescriptions up to $90.

Stay on treatment and enjoy instant savings* with every refill


30-Day Supply 90-Day Supply
Extra $10 when used within 10 days of card activation Extra $10 when used within 10 days of card activation
$10 off each refill

No co-pay

No co-pay

An extra $10 off when refilled within 40 days of last refill An extra $10 off when refilled every 90 days
The formulary status and coverage for RESTASIS® varies greatly across insurance plans. The actual reimbursement for a member’s out-of-pocket costs for RESTASIS® Ophthalmic Emulsion will vary according to refill quantity, personal healthcare insurance coverage, and following product information dosing guidelines. If a member receives reimbursement, they may still be responsible for some out-of-pocket costs. Please review the RESTASIS® My Tears, My Rewards® Program guidelines to learn about savings eligibility.
The program is good for 1 year from first card use.
Please visit mytearsmyrewards.com for more information.
If your mail-order pharmacy does not accept your MTMR Card,
click here for a mail-order rebate.

If you don't qualify for the MTMR Program, sign up for the My Tears, My Support™ Program.

RESTASIS® (Cyclosporine Ophthalmic Emulsion) 0.05% Rebate Terms and Conditions:

To receive a rebate for the amount of your prescription co-pay (up to $20), enclose this certificate and the ORIGINAL pharmacy receipt in an envelope and mail to

Allergan RESTASIS® Ophthalmic Emulsion $20 Rebate Program
P.O. Box 6513
West Caldwell, NJ 07007
Please allow 8 weeks for receipt of rebate check.

Receipts prior to June 27, 2014 will not be accepted. One rebate per consumer. Duplicates will not be accepted. See rebate certificate for expiration date.

Eligibility

Offer not valid for prescriptions reimbursed or paid under Medicare, Medicaid, or any similar federal or state healthcare program including any state medical or pharmaceutical assistance programs. Offer void where prohibited by law, taxed, or restricted. Amount of rebate not to exceed $20 or co-pay, whichever is less. This certificate may not be reproduced and must accompany your request for a rebate. Offer good only for one prescription of RESTASIS® Ophthalmic Emulsion and only in the USA and Puerto Rico. Allergan, Inc., reserves the right to rescind, revoke, and amend this offer without notice. You are responsible for reporting receipt of a rebate to any private insurer that pays for, or reimburses you, for any part of the prescription filled, using this certificate.

within

Approved Use
RESTASIS® (Cyclosporine
Ophthalmic Emulsion) 0.05% helps increase your eyes’ natural ability to produce tears, which may be reduced by inflammation due to Chronic Dry Eye. RESTASIS® did not increase tear production in patients using anti-inflammatory eye drops or tear duct plugs.

Important Safety Information
Do not use RESTASIS® Ophthalmic Emulsion if you are allergic to any of the ingredients. To help avoid eye injury and contamination, do not touch the vial tip to your eye or other surfaces. See more below >