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My Tears, My Rewards® Program Terms and Conditions

RESTASIS® (Cyclosporine Ophthalmic Emulsion) 0.05% My Tears, My Rewards® is a savings, counseling, and support program offered to eligible patients free of charge. You can enroll and obtain your My Tears, My Rewards® Savings Card through this website, at participating physicians' offices, by calling the toll-free customer service support line 1-844-4MY-TEARS (1-844-469-8327), or through a printed offer.

Eligibility

This program is offered only in the United States and Puerto Rico.

According to state and federal laws, patients covered by Medicare, Medicaid, or a similar federal or state healthcare program are not eligible for savings programs.

My Tears, My Rewards® Savings Card

If you printed a Savings Card from this website, it is already activated and you can start using it instantly.

If you received your Savings Card from your doctor, or in the mail, activate it here or call 1-844-4MY-TEARS (1-844-469-8327) and select option 2.

Go to your pharmacy and present your Savings Card along with your RESTASIS® prescription to your pharmacist.

My Tears, My Rewards® RESTASIS MultiDose® Prescription

Most eligible patients pay as little as $5* for 3 bottles of RESTASIS MultiDose®. Patients can also pay as little as $5* for 1 bottle of RESTASIS MultiDose®.

My Tears, My Rewards® RESTASIS® Single-use Vials Prescription

Most eligible patients pay as little as $35* for a 90-day supply of RESTASIS® single-use vials. Patients can also pay as little as $35* for a 30-day supply of RESTASIS® single-use vials.

RESTASIS® My Tears, My Rewards® Program for Mail-Order/Manual Claims

If your mail-order pharmacy or pharmacy does not accept your Savings Card, get a claim form here. Print and complete the form, attach your receipt, and send both to the address on the form:

RESTASIS® and RESTASIS MultiDose® Claims Processing Department, PO Box 2355, Morristown, NJ 07962

You will be mailed a check for the applicable benefit amount. In 3 to 6 weeks your check will arrive in the mail.

My Tears, My Rewards® Savings Card Expiration and Re-enrollment

Your My Tears, My Rewards® Savings Card expires 12 months from first use.

If your Savings Card expires, to get a new one just enroll again here or call 1-844-4MY-TEARS (1-844-469-8327) and select option 2. You will instantly get a new Savings Card and other materials necessary to continue to benefit from the program if you:

Actively participate in the program
Use your Savings Card per instructions provided

Allergan reserves the right to revise or discontinue this program at any time and without prior notice or recourse.

*Up to a $300 savings for 3 bottles of RESTASIS MultiDose® or a 90-day supply of RESTASIS® single-use vials. Up to a $200 savings for 1 bottle of RESTASIS MultiDose® or a 30-day supply of RESTASIS® single-use vials. Patients whose prescriptions will be paid for in part or in whole by Medicare, Medicaid, or any similar federal or state healthcare program are not eligible for savings or rebates according to federal and state law.

The actual savings on your out-of-pocket costs for RESTASIS MultiDose® and RESTASIS® will vary according to refill quantity and personal healthcare insurance coverage. Please review the My Tears, My Rewards® Program guidelines to learn more.

Actively participating is defined as: using at least 3 times in the last 10 months for those with 30-day prescriptions and using at least twice in the last 10 months for those with 90-day prescriptions.