MOST ELIGIBLE COMMERCIALLY-INSURED PATIENTS MAY PAY AS LITTLE AS $0^*

RESTASIS® offers a savings program called My Tears, My Rewards^®. Most eligible commercially-insured patients may pay as little as $0* for a 90-day supply. Sign up for a Savings Card through My Tears, My Rewards^® below.

*Maximum savings limits apply; patient out-of-pocket expense will vary depending on insurance coverage. Offer valid for patients with commercial prescription insurance coverage and a valid prescription for RESTASIS^® or RESTASIS MultiDose^®. Offer not valid for patients enrolled in Medicare, Medicaid, or any other federal, state, or government-funded healthcare program. See My Tears, My Rewards^® Savings Program Terms, Conditions, and Eligibility Criteria at bottom of page.

STEP 1

CHECK YOUR SAVINGS CARD ELIGIBILITY

Do you live in the United States, including Puerto Rico?

PLEASE INDICATE "YES" OR "NO"

YES NO

Are you enrolled in Medicare, Medicaid, or another federal-, state-, or government-funded healthcare program?

PLEASE INDICATE "YES" OR "NO"

YES NO

Do you certify that you understand and agree to comply with the Terms, Conditions, and Eligibility Criteria listed at the bottom of this page?

PLEASE INDICATE "YES" OR "NO"

YES NO

Based on the information you provided, you are not eligible to participate in this program.

Sorry, you are not eligible for the My Tears, My Rewards^® Savings Card. Patients whose prescriptions are covered by Medicare, Medicaid, or a similar federal or state prescription drug program are not eligible for savings programs. Please see Terms, Conditions and Eligiblity for details.

DISCOVER SUPPORT AND SAVINGS

Sign up for the My Tears, My Support^® program in order to receive information about Restasis^® and other Allergan and AbbVie products and services.

STEP 2

ENTER YOUR CONTACT INFORMATION

*Required information

FIRST NAME*

PLEASE ENTER YOUR FIRST NAME

LAST NAME*

PLEASE ENTER YOUR LAST NAME

ADDRESS*

PLEASE ENTER YOUR ADDRESS

CITY*

PLEASE ENTER YOUR CITY

STATE*

PLEASE ENTER YOUR STATE

ZIP CODE*

PLEASE ENTER YOUR ZIP CODE

PLEASE ENTER YOUR MOBILE NUMBER

PHONE NUMBER NOT VALID

EMAIL*

PLEASE ENTER YOUR EMAIL

Yes, I would like to receive email communications from Allergan, an AbbVie company, related to Restasis^®, Restasis MultiDose^®, and the My Tears, My Rewards^® Savings Program, including site updates, patient education, as well as other AbbVie products and services. I understand that the information pertaining to me that AbbVie collects will be used in accordance with AbbVie's Privacy Notice. If I later wish to stop receiving certain communications, I understand that I may unsubscribe by clicking on the link provided in future emails.

Yes, I would like to receive updates and offers from My Tears, My Support^® sent to my mobile device. I understand that the frequency of these recurring messages depends on user preference/activity and that message and data rates may apply. I understand that I can unsubscribe at any time by simply texting “STOP” and receive help by texting “HELP” to 72428. Consent to texts not required to sign up for card. SMS Privacy Terms and SMS Terms & Conditions

STEP 2

ENTER YOUR CONTACT INFORMATION

*Required information

FIRST NAME*

PLEASE ENTER YOUR FIRST NAME

LAST NAME*

PLEASE ENTER YOUR LAST NAME

ADDRESS*

PLEASE ENTER YOUR ADDRESS

CITY*

PLEASE ENTER YOUR CITY

STATE*

PLEASE ENTER YOUR STATE

BASED ON THE INFORMATION PROVIDED, YOU ARE NOT ELIGIBLE TO PARTICIPATE IN THE PROGRAM. THANK YOU FOR YOUR INTEREST

ZIP CODE*

PLEASE ENTER YOUR ZIP CODE

PLEASE ENTER YOUR MOBILE NUMBER

PHONE NUMBER NOT VALID

EMAIL*

PLEASE ENTER YOUR EMAIL

Yes, I would like to receive email communications from Allergan, an AbbVie company, related to Restasis®, Restasis MultiDose^®, and the My Tears, My Rewards^® Savings Program, including site updates, patient education, as well as other AbbVie products and services. I understand that the information pertaining to me that AbbVie collects will be used in accordance with AbbVie's Privacy Notice. If I later wish to stop receiving certain communications, I understand that I may unsubscribe by clicking on the link provided in future emails.

Yes, I would like to receive updates and offers from My Tears, My Rewards^® sent to my mobile device. I understand that the frequency of these recurring messages depends on user preference/activity and that message and data rates may apply. I understand that I can unsubscribe at any time by simply texting “STOP” and receive help by texting “HELP” to 72428. Consent to texts not required to sign up for card. SMS Privacy Terms and SMS Terms & Conditions

MY TEARS, MY REWARDS^® SAVINGS CARD

Print your Savings Card now!

Download your Savings Card now

For answers to questions about RESTASIS^® and the My Tears, My Rewards^® Program, call the toll-free customer service support line 1-844-4MY-TEARS (1-844-469-8327).

My Tears, My Rewards^® Savings Program Terms, Conditions, and Eligibility Criteria:

1. This offer is valid only for patients who have commercial insurance coverage and a valid prescription for an approved use of RESTASIS® (cyclosporine ophthalmic emulsion) 0.05% single-dose vials or RESTASIS MultiDose^® bottles at the time the prescription is filled by the pharmacist and dispensed to the patient. 2. This offer is not valid for use by patients enrolled in any federal, state, or government-funded healthcare programs (e.g., Medicare, Medicare Advantage, Medigap, Medicaid, TRI CARE, Department of Defense, or Veterans Affairs programs); private indemnity or HMO insurance plans that reimburse patients for the entire cost of their prescription drugs; or where prohibited by the patient's health insurance provider. If at any time a patient begins receiving prescription drug coverage under any federal, state, or government-funded healthcare program, patient will no longer be eligible to participate in the My Tears, My Rewards^® Savings Program. This offer is not valid for cash-paying patients. 3. Depending on insurance coverage, eligible patients may pay as little as $0 for each of up to twelve (12) 30-day prescription fills of RESTASIS® single-use vials OR each of up to four (4) 90-day prescription fills of RESTASIS® single-use vials. OR, depending on insurance coverage, eligible patients may pay as little as $0 for each of up to twelve (12) one-bottle (30-day supply) prescription fills of RESTASIS MultiDose^® OR each of up to four (4) three-bottle (90-day supply) prescription fills of RESTASIS MultiDose^®. Check with pharmacist for copay discount. Subject to all other terms and conditions, the maximum savings that may be available solely for the patient’s benefit under the My Tears, My Rewards^® Savings Program is $255 per 30-day prescription fill of RESTASIS^® single-use vials and $300 per 90-day prescription fill of RESTASIS^® single-use vials, and $255 per 30-day prescription fill of RESTASIS MultiDose^® and $300 per 90-day prescription fill of RESTASIS MultiDose^®. The actual application and use of the savings available through this offer may vary on a monthly, quarterly, and/or annual basis depending on each individual patient’s insurance plan and other prescription drug costs. 4. Offer applies only to prescriptions filled before program period expires on December 31, 2023. 5. Patients and healthcare providers may not seek reimbursement for value received from the My Tears, My Rewards^® Savings Program from any third-party payers. 6. Allergan, an AbbVie company, reserves the right to rescind, revoke, or amend this offer without notice. 7. Offer good only in the USA, including Puerto Rico and Guam, at participating retail pharmacies. Patients residing in certain states may not be eligible to participate in this program. 8. Void if prohibited by law, taxed, or restricted. 9. This offer is not transferable. The selling, purchasing, trading, or counterfeiting of this offer is prohibited by law. 10. This offer has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription. 11. This offer is not health insurance. 12. Offer expires December 31, 2023. 13. By redeeming this offer, patient represents they meet the eligibility criteria above and patient understands and agrees to comply with the terms and conditions of this offer.

For questions about this program, please call 1-844-4MY-TEARS (1-844-469-8327).

Pharmacist Instructions for a Patient with an Eligible Third-Party Payer: When you redeem this card, you certify that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other government programs for this prescription. Submit the claim to the primary Third-party Payer first, then submit the balance due to Change Healthcare using BIN #004682 as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code (e.g., 8). If you receive a rejection due to PA, step-edit, or NDC block, submit Other Coverage Code of 03 (Secondary Claim). The patient's out-of-pocket expense will be reduced up to the maximum savings limit for the program. Reimbursement will be received from Change Healthcare. For any questions regarding Change Healthcare online processing, call 1-866-371-9066.

Program managed by ConnectiveRx on behalf of Allergan, an AbbVie company

APPROVED USE

RESTASIS^® and RESTASIS MultiDose^® Ophthalmic Emulsion help increase your eyes’ natural ability to produce tears, which may be reduced by inflammation due to Chronic Dry Eye. RESTASIS® and RESTASIS MultiDose^® did not increase tear production in patients using anti-inflammatory eye drops or tear duct plugs.

IMPORTANT SAFETY INFORMATION

Do not use RESTASIS^® and RESTASIS MultiDose^® Ophthalmic Emulsion if you are allergic to any of the ingredients. Be careful not to touch the container tip to your eye or other surfaces, to help avoid eye injury and contamination. RESTASIS^® and RESTASIS MultiDose^® should not be used while wearing contact lenses. If contact lenses are worn, they should be removed prior to use of RESTASIS^® and RESTASIS MultiDose^® and may be reinserted after 15 minutes.

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 FDA Goverment Website, or call 1-800-FDA-1088.

Click here for full Product Information for RESTASIS^® and RESTASIS MultiDose^® .

APPROVED USE

RESTASIS^® and RESTASIS MultiDose^® Ophthalmic Emulsion help increase your eyes’ natural ability to produce tears, which may be reduced by inflammation due to Chronic Dry Eye. RESTASIS^® and RESTASIS MultiDose^® did not increase tear production in patients using anti-inflammatory eye drops or tear duct plugs.

IMPORTANT SAFETY INFORMATION

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 FDA Goverment Website, or call 1-800-FDA-1088.

Click here for full Product Information for RESTASIS^® and RESTASIS MultiDose^® .

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MOST ELIGIBLE COMMERCIALLY-INSURED PATIENTS MAY PAY AS LITTLE AS $0*

STEP 1

DISCOVER SUPPORT AND SAVINGS

STEP 2

STEP 2

MOST ELIGIBLE COMMERCIALLY-INSURED PATIENTS MAY PAY AS LITTLE AS $0^*