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SAVE NOW!

Instant savings for eligible patients on a MOXEZA® Solution prescription

  • Ask your pharmacist to manually input the codes from your printable rebate or mobile device
  • Make sure your pharmacy fills your prescription exactly as written
  • There is no generic version of MOXEZA® Solution

CLICK HERE FOR TERMS AND CONDITIONS

SAVE NOW!

Instant savings on a MOXEZA® Solution prescription for eligible patients

  • Ask your pharmacist to manually input the codes from your printable rebate or mobile device
  • Make sure your pharmacy fills your prescription exactly as written
  • There is no generic version of MOXEZA® Solution

CLICK HERE FOR TERMS AND CONDITIONS

Tap here for Terms and Conditions

RxBIN: 610524
RxPCN: Loyalty
RxGRP: 50777066
ISSUER: (80840)
ID #:

Offer Expires: 03/31/2016

PRINT YOUR REBATE

*Terms and Conditions:

A patient is eligible for this promotion if their commercial health plan co-pay for MOXEZA® Solution is more than $25 or if they have no insurance. This offer is not valid for patients who are enrolled in Medicare Part D, Medicaid, Medigap, VA, DOD, Tricare, or any other government-run or government sponsored health care program with a pharmacy benefit.

Offer applies only to MOXEZA® Solutions prescriptions filled on or before 3/31/2016.

Eligible commercially insured patients pay as little as $25 in out-of-pocket expenses for each 3 mL bottle of MOXEZA® Solution with a maximum benefit per bottle of $75. Eligible uninsured, cash paying patients save up to $40 on actual out-of-pocket costs off the usual and customary retail price for each 3 mL bottle of MOXEZA® Solution. Offer good for up to three (3) 3 mL bottles of MOXEZA® Solution for a single patient. No other purchase is necessary. This offer may not be combined with any other savings, discount, free trial, or other similar offer for the same prescription. The Program Savings Card is not transferable and is void if reproduced. The Program Savings Card is not health insurance. Alcon reserves the right to rescind, revoke or amend this offer without notice at any time. Use of this Program Savings Card is subject to applicable state and federal law and is void where prohibited.

Patient Instructions:

You must present this card to the pharmacist along with your prescription to participate in this program. The prescriber ID# must be identified on the prescription. When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions and that you will comply with them. You may not use this card if prohibited by your insurer. You are responsible for any reporting of the use of this card required by your insurer. If you have any questions, please call 1-844-236-8027 (8:00 am to 8:00 pm ET, Monday-Friday).

Pharmacist Instructions for a Patient with an Eligible Third Party:

When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, government-run or government sponsored health care program with a pharmacy benefit. If primary coverage exists, input card information as secondary coverage (not to exceed the co-pay amount or $75, whichever is less) and transmit using the COB segment of the NCPDP transaction. Submit transaction to McKesson Corporation using BIN #610524. Acceptable discounts will be displayed in the transaction response. Acceptance of this card and your submission of claims are also subject to the Terms and Conditions posted at www.mckesson.com/mprstnc.

Pharmacist Instructions for an Uninsured Patient:

For uninsured cash-paying patients, submit transaction to McKesson Corporation using BIN #610524. Acceptable discounts will be displayed in the transaction response. Acceptance of this card and your submission of claims are also subject to the Terms and Conditions posted at www.mckesson.com/mprstnc.

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