STEP 1

CHECK YOUR SAVINGS CARD ELIGIBILITY

Are you enrolled in Medicare, Medicaid, or a federal or state prescription drug program?

Sorry, you are not eligible for the My Tears, My Rewards® Savings Card. Patients who are enrolled in Medicare, Medicaid, or a similar federal or state prescription drug program are not eligible for savings programs. Please see Terms and Conditions for details.

STEP 2

ENTER YOUR CONTACT INFORMATION

*Required information

PLEASE ENTER YOUR FIRST NAME
PLEASE ENTER YOUR LAST NAME
PLEASE ENTER YOUR ADDRESS
PLEASE ENTER YOUR CITY
PLEASE ENTER YOUR STATE
PLEASE ENTER YOUR ZIP CODE
PLEASE ENTER YOUR MOBILE NUMBER PHONE NUMBER NOT VALID
PLEASE ENTER YOUR EMAIL

MY TEARS, MY REWARDS® SAVINGS CARD DELIVERY OPTIONS

My Tears, My Rewards® savings card icon
My Tears, My Rewards® savings card icon

USING YOUR
SAVINGS CARD

Present your savings card along with your RESTASIS® or RESTASIS MultiDose® prescription to your pharmacist. If your mail-order pharmacy or retail pharmacy does not accept your savings card, get a claim form. Print and complete the form, attach your receipt, and send both to the address on the form. Your check will arrive in the mail in 3 to 6 weeks.

Cliam IconCLAIM FORM

Learn more about RESTASIS® pricing and savings information here.

RESTASIS® PRICING

CONTACT US

For answers to questions about RESTASIS® and the My Tears, My Rewards® Program, call the toll-free customer service support line 1-844-4MY-TEARS (1-844-469-8327).

For answers to questions about RESTASIS® and the My Tears, My Rewards® Program, call the toll-free customer service support line 1-844-4MY-TEARS (1-844-469-8327).

APPROVED USE -

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

IMPORTANT SAFETY INFORMATION + -

Do not use RESTASIS® and RESTASIS MultiDose® Ophthalmic Emulsion if you are allergic to any of the ingredients. Be careful not to touch the container tip to your eye or other surfaces, to help avoid eye injury and contamination. RESTASIS® and RESTASIS MultiDose® should not be used while wearing contact lenses. If contact lenses are worn, they should be removed prior to use of RESTASIS® and RESTASIS MultiDose® and may be reinserted after 15 minutes.

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® and RESTASIS MultiDose®.

*Up to a $300 savings for a 90-day supply of RESTASIS® single-use vials or up to a $255 savings for a 30-day supply of RESTASIS® single-use vials. Up to a $300 savings for 3 bottles of RESTASIS MultiDose® or up to a $250 savings for 1 bottle of RESTASIS MultiDose®. Patients who are enrolled in Medicare, Medicaid, or any similar federal or state healthcare program are not eligible for savings or rebates according to federal and state law. Offer applies only to prescriptions filled before the program expires on 12/31/20.

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.

APPROVED USE
-

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

IMPORTANT SAFETY INFORMATION

Do not use RESTASIS® and RESTASIS MultiDose® Ophthalmic Emulsion if you are allergic to any of the ingredients. Be careful not to touch the container tip to your eye or other surfaces, to help avoid eye injury and contamination. RESTASIS® and RESTASIS MultiDose® should not be used while wearing contact lenses. If contact lenses are worn, they should be removed prior to use of RESTASIS® and RESTASIS MultiDose® and may be reinserted after 15 minutes.

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® and RESTASIS MultiDose®.

*Up to a $300 savings for a 90-day supply of RESTASIS® single-use vials or up to a $255 savings for a 30-day supply of RESTASIS® single-use vials. Up to a $300 savings for 3 bottles of RESTASIS MultiDose® or up to a $250 savings for 1 bottle of RESTASIS MultiDose®. Patients who are enrolled in Medicare, Medicaid, or any similar federal or state healthcare program are not eligible for savings or rebates according to federal and state law. Offer applies only to prescriptions filled before the program expires on 12/31/20.

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.