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Eligibility Requirements

• Eligible patients with commercial insurance will pay as little as $0 for their monthly prescriptions, up to a maximum benefit amount applied per calendar year. Eligible patients without commercial insurance may still save up to 50% on their monthly prescription, up to a maximum benefit amount applied per calendar year. Offer valid for up to 12 uses. A valid Prescriber ID# is required on the prescription.
• Restrictions: This offer is valid in the United States and Puerto Rico. Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, TRICARE, or other federal or state health programs (such as medical assistance programs). Cash Discount Cards and other noninsurance plans are not valid as primary under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. By using this offer, the patient certifies that he will comply with any terms of his health insurance contract requiring notification to his payer of the existence and/or value of this offer. Offer not valid for patients under 18 years of age. It is illegal to (or offer to) sell, purchase, or trade this offer. This offer is not transferable and is limited to one offer per person. Not valid if reproduced. Void where prohibited by law. Tolmar reserves the right to rescind, revoke, or amend this offer without notice at any time.