Save on Rhopressa®

Reduce the cost of your prescription* with the Rhopressa® Savings Card!

Pay as little as 25*

with eligible commercial insurance where Rhopressa® is covered

Pay as little as 50*

with eligible commercial insurance where Rhopressa® is not covered

Download the Rhopressa® Savings Card and present it to your pharmacist with your prescription

Download the Rhopressa® Savings Card

*Restrictions apply. Patients with State or Federal prescription coverage, such as Medicare or Medicaid, are excluded. See terms and conditions.

Patient Instructions: In order to redeem this offer you must have a valid prescription for Rocklatan® or Rhopressa®. This offer may not be redeemed for cash. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described in the Restrictions section below. Patients who are enrolled in a state or federally funded prescription insurance program, such as Medicare or Medicaid, are excluded. Patients with questions about the Rocklatan® or Rhopressa® Savings offer should call 1-844-807-9706.

Eligible commercially insured patients with coverage for Rocklatan® or Rhopressa® will pay the first $25 per 30-day supply, maximum savings limit applies; patient out-of-pocket expense may vary. Offer valid up to 12 qualifying prescriptions.

Eligible commercially insured patients who are not covered for Rocklatan® or Rhopressa® will pay the first $50 per 30-day supply, maximum savings limit applies; patient out-of-pocket expense may vary. Offer valid for up to 6 qualifying prescriptions.

Pharmacist instructions for patients with commercial insurance coverage for Rocklatan® or Rhopressa®: Submit the claim to the primary commercial insurance company first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 8. The patient is responsible for the first $25. Reimbursement will be received from CHANGE HEALTHCARE.

Pharmacist instructions for patients with commercial insurance that are not covered: Submit this claim to CHANGE HEALTHCARE. A valid Other Coverage Code of 3 is required. The patient is responsible for the first $50. Reimbursement will be received from CHANGE HEALTHCARE.

For any questions regarding CHANGE HEALTHCARE online processing, please call the Help Desk 1-800-433-4893.

Restrictions: This offer is valid for eligible residents of the United States only. This offer is void in U.S. territories including, but not limited to, Puerto Rico. Offer not valid for prescriptions reimbursed under Medicare, a Medicaid drug benefit plan, TRICARE, CHAMPUS or other federal or state health programs. Offer may not be combined with any savings, discount, trial or similar offer for the same prescription. No other purchase is necessary. Coupon is not insurance. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payor 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, trade, or counterfeit this offer. This offer is not transferable. Void where prohibited by law. Absent a change in Massachusetts law, for Massachusetts residents only, this offer will expire on December 31, 2019. Program managed by ConnectiveRx on behalf of Aerie Pharmaceuticals. Aerie Pharmaceuticals reserves the right to rescind, revoke or amend this offer without notice at any time.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

Bacterial Keratitis: Avoid allowing the tip of the bottle to touch the eye to avoid bacterial eye infection which has been reported with the use of multiple-dose containers of topical ophthalmic products.

Contact Lenses: Contact lenses should be removed prior to using Rhopressa® and may be reinserted 15 minutes following its administration.

ADVERSE REACTIONS

The most common ocular adverse reaction observed in controlled clinical studies with Rhopressa® dosed once daily was red eyes, in 53% of patients. Six percent of patients discontinued therapy due to red eyes. Other common (approximately 20%) adverse reactions were: small deposits on the outer surface of the eye, mild pain upon instillation, and broken blood vessels on the white of the eye. Instillation site redness, corneal staining, blurred vision, increased tearing, redness of eyelid, and reduced visual acuity were reported in 5-10% of patients.

The small deposits on the outer surface of the eye seen in Rhopressa®-treated patients were first noted at 4 weeks of daily dosing. This reaction did not result in any apparent visual functional changes. Most small deposits on the outer surface of the eye resolved upon discontinuation of treatment.

Please see full Rhopressa® 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.

INDICATION

Rhopressa® (netarsudil ophthalmic solution) 0.02% is a prescription medication for the treatment of high eye pressure/intraocular pressure (IOP) in people with open-angle glaucoma or ocular hypertension.

DOSAGE AND ADMINISTRATION

The recommended dosage is one drop in the affected eye(s) once daily in the evening.

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IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

Bacterial Keratitis: Avoid allowing the tip of the bottle to touch the eye to avoid bacterial eye infection which has been reported with the use of multiple-dose containers of topical ophthalmic products.

Contact Lenses: Contact lenses should be removed prior to using Rhopressa® and may be reinserted 15 minutes following its administration.

ADVERSE REACTIONS

The most common ocular adverse reaction observed in controlled clinical studies with Rhopressa® dosed once daily was red eyes, in 53% of patients. Six percent of patients discontinued therapy due to red eyes. Other common (approximately 20%) adverse reactions were: small deposits on the cornea, mild pain upon instillation, and broken blood vessels on the white of the eye. Instillation site redness, corneal staining, blurred vision, increased tearing, redness of eyelid, and reduced visual acuity were reported in 5-10% of patients.

The small deposits on the outer surface of the eye seen in Rhopressa®-treated patients were first noted at 4 weeks of daily dosing. This reaction did not result in any apparent visual functional changes. Most small deposits on the outer surface of the eye resolved upon discontinuation of treatment.

Please see full Rhopressa® 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.

INDICATION

Rhopressa® (netarsudil ophthalmic solution) 0.02% is a prescription medication for the treatment of high eye pressure/intraocular pressure (IOP) in people with open-angle glaucoma or ocular hypertension.

DOSAGE AND ADMINISTRATION

The recommended dosage is one drop in the affected eye(s) once daily in the evening.