Patient Savings Program
Pay no more than $10 for a one month supply of LACRISERT®. Offer available to many patients, subject to eligibility with maximum discount of $100.
|Step 1:||Enter your contact information below to receive a coupon that allows you to pay no more than $10 for a one month supply of LACRISERT®. Select the box on the form below if you would also like to learn more about LACRISERT®.
Valeant Ophthalmology will only use this information to to provide you with this coupon, unless you click the box on the form below indicating that you would like to receive free LACRISERT® information.
|Step 2:||Once the information is submitted, press the button to view and print your discount coupon. Only 1 discount coupon is valid per prescription. The discount will be in the amount of your copay, up to $100.|
Indications and Usage
LACRISERT® is indicated in patients with moderate to severe Dry Eye syndromes, including keratoconjunctivitis sicca. LACRISERT® is indicated especially in patients who remain symptomatic after an adequate trial of therapy with artificial tear solutions. LACRISERT® is also indicated for patients with exposure keratitis, decreased corneal sensitivity, and recurrent corneal erosions.
Important Safety Information
LACRISERT® is contraindicated in patients who are hypersensitive to hydroxypropyl cellulose. Instructions for inserting and removing LACRISERT® should be carefully followed. If improperly placed, LACRISERT® may result in corneal abrasion. Because LACRISERT® may cause transient blurred vision, patients should be instructed to exercise caution when driving or operating machinery. Patients should be cautioned against rubbing the eye(s) containing LACRISERT®.
The following adverse reactions have been reported, but were in most instances, mild and temporary: transient blurring of vision, ocular discomfort or irritation, matting or stickiness of eyelashes, photophobia, hypersensitivity, eyelid edema, and hyperemia.
Talk to your doctor if you have side effects that bother you or that do not go away. You are encouraged to report side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.
RESTAT has been authorized to reimburse you up to $100.00 plus an administration fee of $2.00 for processing this certificate, after the patient pays the first $10 when accompanied by a prescription for LACRISERT®. This claim may be submitted electronically through RESTAT or by mail. For reimbursement, follow the instructions listed below. Retain a copy of the coupon and file with the prescription for auditing purposes; return the original coupon to the patient. Please remember to restore patient profile to primary PBM after claim submission.
This claim may be submitted one of the following two ways:
Call 1-866-450-3277 with processing questions.