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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.

Patients not eligible for the My Tears, My Rewards® Program are still eligible to enroll in the RESTASIS® My Tears, My SupportTM Program, which offers members free information and counseling about treatment with RESTASIS®.

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 3.

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

My Tears, My Rewards® 90-Day Prescription

Most commercially insured patients pay $0* (save up to $250) on every refill with 90-day RESTASIS® prescriptions.

Offer only valid for a 90-day prescription which comes with 180 vials. No other refill quantities will qualify.

My Tears, My Rewards® 30-Day Prescription

Most commercially insured patients pay no more than $30* (save up to $250) on every 30-day RESTASIS® prescription.

Offer only valid for a 30-day prescription which comes with 60 vials. No other refill quantities will qualify.

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:

PSKW Attn: RESTASIS® Claims Processing Dept, PO BOX 7017, Bedminster, NJ 07921

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 either 1 year from the date you first use it to pay for a prescription, or if you don't use it by 1/31/2018.

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 3. 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.

*Members 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® will vary according to refill quantity, personal healthcare insurance coverage, and adherence to FDA dosing guidelines. 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.