RESTASIS® Vials

Sign Up For a $20 Mail-in Rebate*
on Your First RESTASIS® Prescription!

Once you sign up, you will be able to download:

  • A $20 mail-in rebate for your first prescription of RESTASIS®
  • A brochure that explains how RESTASIS® can help with your type of Chronic Dry Eye disease

GETTING AND USING YOUR REBATE

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Download Mail-in Rebate From restasis.com

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Talk to an Eye Doctor

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Get a Prescription for RESTASIS® From Your Eye Doctor

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Get Your RESTASIS® Prescription Filled and Save Your Pharmacy Invoice

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Mail in Your Rebate and Pharmacy Invoice

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Get Your $20 Check and Your RESTASIS® Advantage Pack!

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

Read the rebate offer Terms and Conditions.


To receive your rebate, special offers, and information from RESTASIS® please complete the information below.

If your prescription will be paid in part or in whole by a federal or state healthcare program, you do not qualify for the Rebate Offer.


*Required information














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


Sign up for the chance to participate in market research.

Allergan occasionally engages third-party firms to conduct consumer-based market research studies about our products or the health conditions they treat. By checking this box and opting in and providing the requested information, you are agreeing to be contacted about future research opportunities. Your information will only be used for the purpose of market research and will not be sold or distributed to any outside party for any other use.



See Allergan's Privacy Statement.





Go to next page: My Tears, My Rewards®

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 >

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 invoice in an envelope. Keep a copy of the invoice for your records
  • Mail to:
    Allergan RESTASIS® $20 Rebate Program
    P.O. Box 6513 West Caldwell, NJ 07007
  • Allow 4 weeks for receipt of rebate check

If you have any questions about receiving your check, call the RESTASIS® Patient Support Center (1-866-572-5931)

Invoices prior to August 26, 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.

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If you think you may have Chronic Dry Eye disease, don't wait!

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*Yes, I would like to receive information about RESTASIS® and other products and disease states from Allergan. I understand that I can opt-out of receiving e-mails at any time by clicking the unsubscribe link in any e-mail.

See Allergan's Privacy Statement.


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*Required information









*Yes, I would like to receive information about RESTASIS® and other products and disease states from Allergan. I understand that I can opt-out of receiving e-mails at any time by clicking the unsubscribe link in any e-mail.

See Allergan's Privacy Statement.