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SAVE NOW!

Instant savings on CIPRODEX® Otic prescriptions for eligible patients

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

Click here for Terms and Conditions

SAVE NOW!

Instant savings on CIPRODEX® Otic prescription for eligible patients

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

Tap here for Terms and Conditions

BIN: 610524
RxPCN: Loyalty
RxGRP: 50776404
ISSUER: (80840)
ID#: 066499591
Offer Expires on: 03/31/2015

Tap here for Terms and Conditions

Terms and Conditions:

A patient is eligible for this promotion if their commercial health plan co‐pay for CIPRODEX® Otic is more than $25. Commercially insured patients will receive instant savings of up to $150 on out of pocket costs over $25. An eligible patient can use this discount card up to 3 times. Patients without private insurance are ineligible for this program.

The program is offered by Alcon and applies only to CIPRODEX® (ciprofloxacin 0.3% and dexamethasone 0.1%) Sterile Otic Suspension prescriptions filled on or before 3/31/15 for which patient has private insurance copay requirement of $25 or more. 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.

Each patient pays no more than $25 in out‐of‐pocket expenses for CIPRODEX® Otic. Maximum benefit per bottle is $150. Commercially insured patients will receive savings of up to $150 on out of pocket costs over $25. Offer good for up to three (3) 7.5mL bottles of CIPRODEX® Otic for a single patient. Use of the card does not obligate the patient to use or continue using any Alcon product. No other purchase is necessary. You may use the card at any participating pharmacy in the U.S. The card: (a) may not be combined with any other savings, discount, free trial, or other similar offer for the same prescription; (b) is not transferrable, is void if reproduced, and has no cash value; and (c) is not health insurance. Limit one (1) card per patient. Alcon reserves the right to rescind, revoke or amend this offer without notice and to deny payment for non‐compliance with these terms. This offer expires on March 31, 2015. Use of this card is subject to applicable state and federal laws. If you have any questions, please call McKesson Help Desk at 1‐877‐264‐2440 (8:00am to 8:00pm ET, Monday‐Friday).

Eligibility:

By using the card, you acknowledge that you currently meet the following eligibility criteria, you have: a valid prescription for CIPRODEX® Otic; are subject to a private insurance copay requirement for your prescription; are not enrolled in government‐run or government‐sponsored health care program with a pharmacy benefit; are at least 18 years old; and reside in the United States. No purchase necessary and there are no membership fees.

Patient Instructions:

Present your card to your pharmacist along with an eligible prescription for CIPRODEX® Otic each time you fill your prescription. The prescriber ID# must be identified on the prescription. 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. It is important to make sure that you comply with your health insurer’s policies about copay cards. In addition, you agree that you will disclose this offer to your private insurer, if any. You are responsible for any applicable taxes.

Pharmacist Instructions:

By accepting the card, you agree to the Terms and Conditions of the card set forth above. You may not advertise or otherwise use the card to promote the services of your pharmacy. You agree that you will comply with the policies of, will inform as required, the patient’s insurer and not request payment from Alcon where copay cards are prohibited by the patient’s insurer or by applicable law. You may not seek reimbursement from a patient or health insurer for amounts provided by Alcon towards the patient’s copay. Please be aware that Alcon may deny payment if you do not comply with the terms of this offer. Submit transaction to McKesson Corporation using BIN #610524. If primary coverage exists, input card information as secondary coverage (not to exceed the co‐pay amount or $25, whichever is less) and transmit using the COB segment of the NCPDP transaction. 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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