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

RESTASIS® offers a savings program called RESTASIS^® Savings Program. Most eligible commercially-insured patients may pay as little as $0^* for a 90-day supply. Sign up for a Savings Card 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 RESTASIS^® 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 RESTASIS^® 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 RESTASIS^® Savings Program in order to receive information about RESTASIS^® and AbbVie products and services.

STEP 2

ENTER YOUR CONTACT INFORMATION

*Required information

FIRST NAME*

LAST NAME*

ADDRESS*

CITY*

STATE*

ZIP CODE*

EMAIL*

Yes, I would like to receive email communications from Allergan, an AbbVie company, related to RESTASIS^®, RESTASIS MultiDose^®, and the RESTASIS^® Savings Program, including site updates, patient education, as well as other AbbVie products and services. I consent to the collection, use, and disclosure of my health-related personal data to receive communications from AbbVie regarding its products, programs, services, clinical trials, research opportunities and for online targeted advertising, as further described in the “How We May Use Personal Data,” “How We May Disclose Personal Data,” and “Cookies and Similar Tracking and Data Collection Technologies” sections of our Privacy Notice. My consent is required to process sensitive personal data under certain privacy laws, and I have the right to withdraw my consent by visiting “Your Privacy Choices” on AbbVie’s website.

Privacy Notice:

AbbVie may collect your personal data through your online and offline interactions with us, including your contact, geolocation, and health-related data. We may also collect your online usage data automatically through cookies and similar technologies. + Expand for more information

RESTASIS^® SAVINGS CARD

Print your Savings Card now!

Download your Savings Card now

For answers to questions about RESTASIS^® and the RESTASIS^® Savings Program, call the toll-free customer service support line 1-844-469-8327

For answers to questions about RESTASIS^® and the RESTASIS^® Savings Program, call the toll-free customer service support line 1-844-469-8327.

RESTASIS Program Terms and Conditions

1. This offer is valid only for patients 16 years of age or older and is good for use only with a valid prescription for RESTASIS^® (cyclosporine ophthalmic emulsion) or RESTASIS MultiDose® at the time the prescription is filled by the pharmacist and dispensed to the patient. 2. Depending on your insurance coverage, most eligible patients may pay as little as $0 per 30-day supply for each of up to twelve (12) prescription fills OR per 60-day supply for each of up to six (6) prescription fills OR per 90-day supply for each of up to four (4) prescription fills. Check with your pharmacist for your copay discount. Maximum savings limits apply; patient out-of-pocket expense will vary. 3. This card is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this offer if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. This offer is not valid for cash-paying patients. 4. AbbVie reserves the right to rescind, revoke, or amend this offer without notice. 5. Offer good only in the USA, including Puerto Rico, at participating retail pharmacies. 6. Void where prohibited by law, taxed, or restricted. 7. This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. 8. This card 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. 9. This offer is not health insurance. 10. Subject to all other terms and conditions, the maximum annual benefit that may be available solely for the patient’s benefit under the copay assistance program is $1,200.00 per calendar year. The actual application and use of the benefit available under the copay assistance program may vary on a monthly, quarterly, and/or annual basis depending on each individual patient’s plan of insurance and other prescription drug costs. 11. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer. 12. To learn about AbbVie’s privacy practices and your privacy choices, visit https://abbv.ie/corpprivacy.

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

STEP 1

DISCOVER SUPPORT AND SAVINGS

STEP 2

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