Terms and Conditions | XALATAN® (latanoprost ophthalmic solution)

XALATAN SAVINGS CARD TERMS AND CONDITIONS

By participating in the XALATAN Savings Offer Program, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

  • This Savings Offer is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare, or other federal or state healthcare programs (including any state prescription drug assistance programs) and the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”)
  • You must deduct the savings received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf
  • Eligible patients may pay a minimum of $0 per monthly prescription fill. By using the Savings Offer, eligible patients will receive a savings of up to $125 per fill off their co-pay or out-of-pocket costs. The Savings Offer is good for a maximum savings of $1,500 per year ($125 per month x 12 months). The Savings Offer limits your prescription cost to $0, subject to a $125 maximum monthly benefit. Thus, if your co-pay or out-of-pocket cost is more than $125, you will save $125 off of your co-pay or total out-of-pocket costs. [Example: If your co-pay or out-of-pocket costs are $150, you will pay $25 ($150 - $125 = $25).] If your co-pay or out-of-pocket costs are no more than $125, you pay $0. For a mail-order 3-month prescription, your total maximum savings may be $375 ($125 x 3)
  • This Savings Offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs
  • The Savings Offer is not valid for Massachusetts residents whose prescriptions are covered, in whole or in part, by third-party insurance
  • This Savings Offer is not valid where prohibited by law
  • The Savings Offer cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription
  • The Savings Offer may not be redeemed more than once per month per patient
  • The Savings Offer will be accepted only at participating pharmacies
  • The Savings Offer is not health insurance
  • This Savings Offer is good only in the U.S. and Puerto Rico
  • The Savings Offer is limited to 1 per person during this offering period and is not transferable
  • Pfizer reserves the right to rescind, revoke, or amend the program without notice
  • No membership fees. The Savings Offer and Program expire on 12/31/2020

Visit XALATAN.com for more information about XALATAN. For help with the XALATAN Savings Offer, call 1-866-562-6147, or write: XALATAN Savings, 2250 Perimeter Park Drive, Suite 300, Morrisville, NC 27560.

If your pharmacy does not accept the XALATAN Savings Offer, or if you are redeeming your prescription by mail, pay for your XALATAN prescription as you normally would. Then, make a photocopy of the front of your XALATAN Savings Card as well as the original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled, and mail them both to: XALATAN Savings, 2250 Perimeter Park Drive, Suite 300, Morrisville, NC 27560. Be sure to include your name and mailing address, and a check will be mailed to you within 3 weeks.

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