Tears, Rewards, Savings: The Program Rewards

As an My Tears, My Rewards® (MTMR) Member, you will receive:

  • A series of useful e-mails to support and counsel you through your treatment

  • Access to the RESTASIS® Patient Support Center, where trained representatives and nurses can answer your questions about treatment and address any concerns you may have. Call the Center at 1-866-572-5931

  • An MTMR Program Guide that helps you track your progress in making more of your own tears

  • Free samples of REFRESH® brand artificial tears

  • Continuous rebates that give you the opportunity to save on your out-of-pocket costs on RESTASIS® (Cyclosporine Ophthalmic Emulsion) 0.05% prescriptions

By joining MTMR, you now qualify for substantial savings and rewards:

  • Continuous rebates for potential savings* of hundreds of dollars per year

  • Including extra savings on 90-day prescriptions of RESTASIS®

Stay on Treatment and Enjoy Instant Savings* with Every Refill

Eligible members receive:

Benefits from savings in My Tears, My Rewards® program

The MTMR Card
Add RESTASIS® (Cyclosporine Ophthalmic Emulsion) 0.05% for Rewards and Savings

Earning RESTASIS® savings and other rewards has never been easier with the RESTASIS® MTMR Card! When you sign up today, you'll receive the RESTASIS® Advantage Patient Support Pack containing the card. Look inside for the accompanying instructions to activate the card and join MTMR.

MTMR Program Card is a VISA® Card that provides instant savings on your RESTASIS Prescription co-pay

  • Your prescription information, including whether you are taking a 30-day supply (2 trays—60 vials total) or 90-day supply (6 trays—180 vials total) of RESTASIS® Ophthalmic Emulsion

  • This will be your 11-digit ID number. Just in case you misplace your card—or forget it when it's time for a refill—write this number down. It may be used in place of the card

  • Remember, to receive credit toward your MTMR savings and rewards, you need your card (or account number) when purchasing a 30-day (2 trays—60 vials total) or 90-day (6 trays—180 vials total) RESTASIS® prescription

My Tears, My Support™ (MTMS): Your Partner in Your Journey to Increased Tear Production

Patients who are ineligible for MTMR due to insurance coverage can sign up for the My Tears, My Support™ Program.

As an MTMS Member, you will receive:

My Tears, My Support – Your Partner in Your Journey to Increased Tear Production

  • A series of useful e-mails to support and counsel you through your treatment

  • Access to the RESTASIS® Patient Support Center, where trained representatives and nurses can answer your questions about treatment and address any concerns you may have. Call the Center at 1-866-572-5931

*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 these rebates according to federal and state law.

The actual reimbursement of your out-of-pocket cost—your co-pay—will vary according to refill quantity, personal healthcare insurance coverage, and adherence to product information dosing guidelines. If a member receives reimbursement, they may still be responsible for some out-of-pocket costs. Please consult the terms and conditions to learn about the savings you may be eligible for.

An MTMR Member has exactly one year from the date of their first RESTASIS® Prescription fill to redeem refills toward their rebate rewards. Members may request a new MTMR Card to begin a new reward sequence at the end of the one-year period.

The formulary status and coverage for RESTASIS® varies greatly across insurance plans. The actual reimbursement for a member's out-of-pocket costs for RESTASIS® will vary according to refill quantity, personal healthcare insurance coverage, and following product information dosing guidelines. If a member receives reimbursement, they may still be responsible for some out-of-pocket costs. Please review the RESTASIS® My Tears, My Rewards® Program guidelines to learn about savings eligibility.

Get the Pack to Join the Program. Sign Up and receive the RESTASIS® Advantage Patient Support Pack, your ticket to joining MTMR

Approved Use
RESTASIS® (Cyclosporine Ophthalmic Emulsion) 0.05% helps increase your eyes' natural ability to produce tears, which may be reduced by inflammation due to Chronic Dry Eye. RESTASIS® did not increase tear production in patients using anti-inflammatory eye drops or tear duct plugs.

Important Safety Information
Do not use RESTASIS® Ophthalmic Emulsion if you are allergic to any of the ingredients. To help avoid eye injury and contamination, do not touch the vial tip to your eye or other surfaces.
See more below >

Get the Pack to Join the Program. Sign up and receive the RESTASIS® Advantage Patient Support Pack, your ticket to joining MTMR Join My Tears, My Rewards

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

Important Safety Information
Do not use RESTASIS® Ophthalmic Emulsion if you are allergic to any of the ingredients. To help avoid eye injury and contamination, do not touch the vial tip to your eye or other surfaces. RESTASIS® should not be used while wearing contact lenses. If contact lenses are worn, they should be removed prior to the use.

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 www.fda.gov/medwatch, or call 1-800-FDA-1088.

Click here for full Product Information for RESTASIS® Ophthalmic Emulsion.

Terms of Use
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Terms of Use

Access to and use of this Web site are subject to the following terms and conditions and all applicable laws. If you do not agree with these terms of use, please do not use this Web site. Because we may revise the terms of use from time to time, you should review them periodically.

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You should assume that all contents of the Web site are copyrighted unless otherwise noted and may not be used except as provided herein and without our express written permission. Except as expressly provided above, nothing contained herein shall be construed as conferring any license or right under any Allergan copyright.

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Each person assumes full responsibility and all risks arising from use of the Web site. IN NO EVENT SHALL WE, OR ANY OF OUR AFFILIATES, AND/OR THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, REPRESENTATIVES, INFORMATION PROVIDERS, AND LICENSORS AND/OR THEIR RESPECTIVE HEIRS AND ASSIGNS BE LIABLE FOR ANY DAMAGES OF ANY KIND OR NATURE, INCLUDING, BUT NOT LIMITED TO, DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL, EXEMPLARY, SPECIAL (INCLUDING LOSS OF PROFIT), PUNITIVE, OR OTHER DAMAGES ARISING FROM OR IN CONNECTION WITH THE EXISTENCE OR USE OF THE WEB SITE, REGARDLESS OF WHETHER ALLERGAN OR ANY OF THE OTHER ENTITIES OR PERSONS LISTED ABOVE HAS BEEN ADVISED AS TO THE POSSIBILITY OF SUCH DAMAGES. This includes damages to, or for viruses that may infect your computer equipment. Without limiting the foregoing, everything on the Web site is provided to you "AS IS" AND WE MAKE NO REPRESENTATIONS OR WARRANTIES OF ANY KIND OR NATURE WITH RESPECT TO THIS WEB SITE. WE HEREBY DISCLAIM ALL REPRESENTATIONS AND WARRANTIES, WHETHER EXPRESS OR IMPLIED, CREATED BY LAW, CONTRACT OR OTHERWISE, INCLUDING, BUT NOT LIMITED TO, ANY WARRANTIES OF MERCHANTIBILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, OR NON-INFRINGEMENT. WE MAKE NO REPRESENTATION OR WARRANTY THAT ACCESS TO THE WEB SITE WILL BE AVAILABLE ON A TIMELY BASIS, WILL BE UNINTERRUPTED, OR THAT THE INFORMATION CONTAINED ON THE WEB SITE WILL BE TIMELY OR ERROR FREE. Please note that some jurisdictions may not allow the exclusion of implied warranties, so some of the above exclusions may not apply to you. Check your local laws for any restrictions or limitations regarding the exclusion of implied warranties.

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No information contained on this Web site is provided with the intention to give medical advice or instructions on the accurate use of our products. We cannot answer unsolicited e-mails requesting personal medical advice; visitors should always consult a healthcare professional.

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Any communication or material that you transmit to, or post on, this Web site by electronic mail or otherwise, including any data, questions, comments, suggestions, or the like, is, and will be treated as, non-confidential and nonproprietary information, and we shall have no obligation of any kind with respect to such information. We and any of our affiliates may use such information for any purpose whatsoever, including, but not limited to, reproduction, disclosure, transmission, publication, broadcast, and further posting. Further, we and any of our affiliates shall be free to use such information, including, but not limited to, any ideas, concepts, know-how, or techniques contained therein, for any purpose whatsoever, including, but not limited to, researching, developing, manufacturing, and marketing products incorporating such information.

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My Tears, My Rewards® Program Terms and Conditions

RESTASIS® (Cyclosporine Ophthalmic Emulsion) 0.05% My Tears, My Rewards® is an incentive and counseling program offered to eligible enrollees free of charge. You can enroll by obtaining a RESTASIS® Advantage Patient Support Pack by request through telephone, web, reply to a printed offer, or participating physicians.

Eligibility

This Program cannot be offered to individuals whose prescriptions are paid for in part or in whole by Medicare, Medicaid, or any similar federal or state healthcare program, including any state medical or pharmaceutical assistance programs. Offer void where prohibited by law, taxed, or restricted.

You are responsible for reporting receipt of a rebate to any private insurer that pays for, or reimburses you for, any part of the prescription filled.

This Program cannot be combined with other offers. One per consumer.

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

MTMR Card Savings

The MTMR Card must be activated by calling an automated voice response system. You must provide a valid mailing and e-mail address to receive e-mail communications that offer guidance for treatment and apprise you of cost savings.

To receive credit toward your prescription savings, the MTMR Card must be presented when purchasing a RESTASIS® Ophthalmic Emulsion prescription.

The actual rebate savings amount you are entitled to is equal to your out-of-pocket payment—your co-pay—for each prescription of RESTASIS®, up to the specified rebate savings amount for each refill, whichever is less.

If you use your MTMR Card to fill your RESTASIS® Ophthalmic Emulsion prescription within 10 days of this activation, you may be eligible to receive an additional $10 savings off your first prescription.

MTMR (30-day) Program

For each 30-day RESTASIS® prescription you may be eligible to receive up to $10 off refills 1, 2, 3, 5, 6, 7, 9, 10, and 11 and up to $75 off on refills 4, 8, and 12.

You may be entitled to up to an additional $10 in savings if you refill a 30-day prescription within 40 days of your prior 30-day prescription refill.

Only RESTASIS® Ophthalmic Emulsion prescriptions for a 30-day supply of 2 trays—60 vials total can be redeemed toward these savings. No other refill quantities will qualify.

MTMR (90-day) Program

For each 90-day RESTASIS® prescription you may be entitled to receive up to $90 off refills 1, 2, 3, and 4.

You may be entitled to up to an additional $10 in savings if you refill a 90-day prescription within 100 days of your prior 90-day prescription refill.

Only RESTASIS® Ophthalmic Emulsion prescriptions for a 90-day supply of 6 trays—180 vials total can be redeemed toward these savings. No other refill quantities will qualify.

RESTASIS® My Tears, My Rewards® Program for Mail-Order Pharmacy

If your pharmacy or mail-order pharmacy does not accept the MTMR Card, you can submit a completed Independent Rebate Redemption form and required pharmacy receipt for a 30-day or 90-day supply of RESTASIS® by mail, with proper address and postage, to:

RESTASIS® Claims Processing Dept
P.O. Box 377
Edison, NJ 08818-0377

The applicable benefit amount will be loaded onto your MTMR Card and you will be notified of the amount added.

MTMR Card Expiration and Re-Enrollment

Your MTMR Card is valid for 1 year from the date of the card's first use for your initial RESTASIS® prescription, or on the last day of the expiration month and year designated on your MTMR Card, whichever comes first.

After the expiration of your MTMR Card, you may be entitled to re-enroll pursuant to program rules at that time.

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

 

Approved Use
RESTASIS® Ophthalmic Emulsion is a prescription medicine that helps increase your eyes' natural ability to produce tears, which may be reduced by inflammation due to Chronic Dry Eye. RESTASIS® did not increase tear production in patients using anti-inflammatory eye drops or tear duct plugs.

Important Safety Information
Do not use RESTASIS® Ophthalmic Emulsion if you are allergic to any of the ingredients. To help avoid eye injury and contamination, do not touch the vial tip to your eye or other surfaces. RESTASIS® should not be used while wearing contact lenses. If contact lenses are worn, they should be removed prior to the use.

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 www.fda.gov/medwatch, or call 1-800-FDA-1088.

Click here for Product Information for RESTASIS® Ophthalmic Emulsion.

APC40AB13

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