*AYS Savings Program Terms, Conditions & Eligibility Criteria
1. This offer is valid only for patients who have commercial insurance coverage and a valid prescription for an approved use of LUMIGAN® (bimatoprost ophthalmic solution) 0.01%, COMBIGAN® (brimonidine tartrate/timolol maleate ophthalmic solution) 0.2%/0.5%, or ALPHAGAN® P (brimonidine tartrate ophthalmic solution) 0.1% at the time the prescription is filled by the pharmacist and dispensed to the patient. 2. This offer is not valid for use by patients enrolled in any federal, state, or government-funded healthcare programs (e.g., Medicare, Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs); private indemnity or HMO insurance plans that reimburse patients for the entire cost of their prescription drugs; or where prohibited by the patient’s health insurance provider. If at any time a patient begins receiving prescription drug coverage under any federal, state, or government-funded healthcare program, patient will no longer be eligible to participate in the At Your Service Savings Program. This offer is not valid for cash paying patients. 3. Subject to all other terms and conditions, the maximum annual patient benefit that may be available under the copay assistance program for (a) LUMIGAN® 0.01% is $2,860 per calendar year and $220 per fill for a 30-day supply and $2,000 per calendar year and $400 per fill for a 90-day supply, (b) for ALPHAGAN® P 0.1% is $2,340 per calendar year and $180 per fill for a 30-day supply and $2,000 per calendar year and $400 per fill for a 90-day supply, and (c) for COMBIGAN® is $2,340 per calendar year and $180 per fill for a 30-day supply and $2,000 per calendar year and $400 per fill for a 90-day supply. Maximum savings limits apply; patient out-of-pocket expense will vary. 4. Patients and healthcare providers may not seek reimbursement for value received from the At Your Service Savings Program from any third-party payers. 5. Allergan, an AbbVie company, reserves the right to rescind, revoke, or amend this offer without notice. 6. Offer good only in the USA, including Puerto Rico and Guam, at participating retail pharmacies. Patients residing in certain states may not be eligible to participate in this program. 7. Void if prohibited by law, taxed, or restricted. 8. This offer is not transferable. The selling, purchasing, trading, or counterfeiting of this offer is prohibited by law. 9. This offer has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription. 10. This offer is not health insurance. 11. By redeeming this offer, patient represents they meet the eligibility criteria above and patient understands and agrees to comply with the terms and conditions of this offer.
For questions about this program, please call 1-833-Dial-AYS (1-833-342-5297).
Program managed by ConnectiveRx on behalf of Allergan, Inc., an Abbvie company.