Fill your first RESTASIS® (Cyclosporine Ophthalmic Emulsion) 0.05% prescription to receive 4 great offers!

Registering for more information about RESTASIS® is easy! Just fill out the form below. Once you register, you’ll have access to:

  • Up to $20 RESTASIS® rebate
  • A helpful brochure
  • A FREE subscription to Your Health In Sight®
  • And more information on how RESTASIS® can help your type of Chronic Dry Eye disease

Please note that—according to federal and state laws—this offer is not available to patients enrolled in Medicare, Medicaid, or any other government health program.

Read the rebate offer terms and conditions.

To receive your rebate and special offers, please fill out the information below.

*Required information

*First Name:
 *Last Name:
*Address:
*City:
*State:
*ZIP:
*E-mail:
 *Confirm E-mail:

*I am not currently enrolled or plan to enroll in Medicare, Medicaid, or any
       other government healthcare program.

*Yes, I would like to receive future communications from RESTASIS®.

*Yes, I would like to receive future communications from Allergan, Inc.

Check here if you prefer to receive the helpful brochure by mail. Or leave this box
       blank if you’d rather download the brochure after you complete your
       registration for the rebate.


A NOTE ABOUT PRIVACY
Your answers to the survey questions, along with the answers of other individuals, may be shared in an anonymous fashion with other third parties or governmental agencies for research purposes.

Once your information has been released to Allergan, Inc., it will continue to be protected by Allergan’s privacy policy. It will not, however, have the protections of the federal privacy regulations.

You are responsible for reporting delivery of a rebate to any private insurer that pays for, or reimburses you for, any part of the prescription filled.

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 April 20, 2013 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 >

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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. RESTASIS® should not be used while wearing contact lenses. If contact lenses are worn, they should be removed prior to the use.

The most common side effect is a temporary burning sensation. Other side effects include eye redness, discharge, watery eyes, eye pain, foreign body sensation, itching, stinging, and blurred vision.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Click here for full Product Information for RESTASIS® Ophthalmic Emulsion.

Dr. Tendler is an actual RESTASIS® patient and is compensated for appearing on this website.