Patient: You must present this card to the pharmacist along with
your prescription to participate in this program. This card is good for up to 50%
off the first and second prescription of LASTACAFT® (alcaftadine ophthalmic solution)
0.25%, not to exceed $75 per prescription. The third prescription is covered up
to 100%, not to exceed $100. Total savings on all 3 prescriptions not to exceed
$250. In addition, you can save up to an extra $5 if you fill your prescription
within 7 days of the date it is prescribed. This card must be presented at the
time of each fill for instant savings. Offer is only good at participating retailers.
For any questions, call the LASTACAFT® Savings Program at 1-855-276-2950.
Eligibility: Offer not valid for patients participating in Medicare,
Medicaid, or any similar federal or state healthcare program, including any state
medical or pharmaceutical assistance programs. If patients are eligible for drug
benefits under any such program, they cannot use this coupon. Offer void where prohibited
by law, taxed, or restricted. This promotion cannot be combined with any other programs,
offers, or discounts. Offer good only in the United States. Allergan, Inc., reserves
the right to rescind, revoke, and amend this offer without notice.
Pharmacist instructions for a patient with an Eligible Third Party:
Submit the claim to the primary Third Party Payer first, then submit the balance
due to Therapy First Plus as a Secondary Payer COB (coordinator of benefits) with
the patient responsibility amount and a valid Other Coverage Code (eg, 8). The patient
payment amount will be reduced by 50%, up to $75, on the first and second prescription,
and by 100%, up to $100, on the third prescription. Reimbursement will be received
from Therapy First Plus.
Pharmacist instructions for a cash-paying patient: Submit this
claim to Therapy First Plus. A valid Other Coverage Code (eg, 1) is required. The
patient payment amount will be reduced by 50%, up to $75, on the first and second
prescription, and by 100%, up to $100, on the third prescription. Reimbursement
will be received from Therapy First Plus.
Valid Other Coverage Code required.
For any questions regarding Therapy First Plus online processing, please call the
Help Desk at 1-800-422-5604.
Offer expires December 31, 2016. Good for up to 3 prescriptions.
APPROVED USE
LASTACAFT® is a prescription medicine
approved for the prevention of itching associated with eye allergies.
IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS
LASTACAFT® is contraindicated in patients with hypersensitivity to any component in the product.
WARNINGS AND PRECAUTIONS
To minimize contaminating the dropper tip of the bottle and solution, do
not touch your eyelids or the areas around your eyes with the dropper tip. Keep
bottle tightly closed when not in use.
Do not wear a contact lens if your eye is red.
LASTACAFT® should not be used to treat contact
lens-related irritation.
Remove contact lenses before putting LASTACAFT®
in your eyes. The preservative in LASTACAFT®
may be absorbed by soft contact lenses. Lenses may be put back in your eyes 10 minutes
after using LASTACAFT®.
LASTACAFT® is for topical use in your eyes
only.
SIDE EFFECTS
The most common eye-related side effects that were reported in less than 4% of LASTACAFT®
treated eyes were eye irritation, burning and/or stinging in the eyes after use,
eye redness, and eye itching.
The most common non–eye-related side effects that were reported in less than
3% of patients with LASTACAFT® treated eyes
were inflammation of the nose and the upper part of the throat and headache. Some of these side effects were similar to the symptoms of eye allergies.
Please click here for the full Prescribing Information.
You are encouraged to report negative side effects of prescription drugs to the
FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.