Santen Pharmaceutical

This coupon is not valid for prescriptions paid for in part or full by Medicaid, Tricare, DOD, VA, Medicare Part D, or any state or federally funded program.

Patients whose prescriptions are not covered by either commercial or government insurance or their Medicare Advantage Part D plan may take advantage of this offer.

Click on the link below that best describes your insurance coverage

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^*Do you agree not to seek reimbursement from your Medicare Part D prescription drug plan for your out-of-pocket costs for this prescription product and not to count the costs of this prescription toward your Medicare Part D deductible or True Out of Pocket calculations?

Yes

Terms and Conditions:

For patients whose prescriptions are covered by commercial insurance, use of this card may reduce your copayment to as little as $39.
For patients whose prescriptions are not covered by either commercial insurance or Medicare, use of this card may reduce your cost for prescriptions to as little as $39.

This program is subject to overall maximum support amounts.

This coupon is not valid for prescriptions paid for in part or full by Medicaid, Tricare, DOD, VA, or any state or federally funded program (excluding Medicare).

Patients who have prescription drug coverage under Medicare Part D or Medicare Advantage may be eligible for this offer, provided that they acknowledge that by doing so they will not seek any prescription coverage or reimbursement from their insurer for the cost of prescriptions, or report any amounts paid for prescriptions as part of their "true out-of-pocket expenses" under Medicare Part D or Medicare Advantage prescription drug plan.

I HAVE MEDICARE PART D OR MEDICARE ADVANTAGE INSURANCE If you are 65 years of age or over and your prescriptions are covered by a supplemental prescription plan, you may have Medicare Part D/Medicare Advantage insurance.

I DO NOT HAVE INSURANCE COVERAGE If you do not have any insurance coverage and pay for your prescriptions in cash.