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Patients may be able to save on FLAREX®

Eyevance® is committed to helping all patients have affordable access to FLAREX

Pay as little as $35

For patients for whom FLAREX is covered by commercial insurance.a

OR

Pay as little as $55

For patients for whom FLAREX is not covered by commercial insurance, Medicare Part D, or Medicare Advantage.a

FLAREX is the lowest-cost branded corticosteroid1

aTo the Patient: You must activate and present this card to the pharmacist with a valid prescription to participate in this program. If you have questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the Eyevance Copay Savings Program at 866.747.0976 (8:00 am–8:00 pm EST, Monday–Friday). For patients whose FLAREX prescriptions are covered by commercial insurance, use of this card may reduce your copayment responsibility to as little as $35. For patients whose FLAREX prescriptions are not covered by either commercial or government insurance, use of this card may reduce your cost for FLAREX to as little as $55. This program is subject to overall maximum support amounts and is valid for up to 4 prescriptions. This coupon is not valid for prescriptions paid for in part or full under any state or federally funded program, such as but are not limited to, Medicaid, VA, DOD, or TRICARE, including any state prescription drug assistance programs. Patients who have prescription drug coverage under Medicare Part D or Medicare Advantage may take advantage of this offer, provided they acknowledge that by doing so they will not seek any prescription coverage or reimbursement from their insurer for the cost of FLAREX, or report any amounts paid for FLAREX as part of their “true out-of-pocket expenses” under Medicare Part D or Medicare Advantage. When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions, and that you have responded truthfully to questions when activating the card. This offer expires on 12/31/19.

To the Pharmacist: When you process this card, you are certifying that you have read, understood, and are in compliance with the terms and conditions pertaining to this program. You are further certifying that you have not submitted and will not submit a claim for reimbursement under Medicare Part D or similar federal or state programs, including any state medical pharmaceutical assistance program for this prescription.

  • Submit transaction to McKesson Corporation using [BIN #610524]
  • If primary commercial prescription insurance exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
  • Acceptance of this card and your submission of claims for the Eyevance Copay Savings Program are subject to the LoyaltyScript® program Terms and Conditions posted at https://www.mckesson.com/mprstnc
  • The LoyaltyScript® card is not valid for use with any other prescription drug discount or cash cards for FLAREX. Claims submitted utilizing the program are subject to audit or validation.
  • For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for Eyevance Copay Savings Program at 866.747.0976 (8:00 am–8:00 pm EST, Monday–Friday).

Eyevance reserves the right to rescind, revoke, or amend this offer at any time.

COB=coordination of benefits; NCPDP=National Council for Prescription Drug Programs.

INDICATIONS AND USAGE

FLAREX® (fluorometholone acetate ophthalmic suspension) is indicated for use in the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the eye.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

Contraindicated in acute superficial herpes simplex keratitis, vaccinia, varicella, and most other viral diseases of the cornea and conjunctiva; mycobacterial infection of the eye; fungal diseases; acute purulent untreated infections, which like other diseases caused by microorganisms, may be masked or enhanced by the presence of the steroid; and in those persons who have known hypersensitivity to any component of this preparation.

WARNINGS AND PRECAUTIONS

Topical Ophthalmic Use Only: Not for injection.

Intraocular Pressure Increase: Prolonged use may result in glaucoma, damage to the optic nerve, and defects in visual acuity and visual field. It is advisable that the intraocular pressure be checked frequently.

Cataracts: Use of corticosteroids may result in cataract formation.

Delayed Healing: Topical ophthalmic corticosteroids may slow corneal wound healing. In those diseases causing thinning of the cornea or sclera, perforation has been known to occur with chronic use of topical steroids.

Viral Infections: Use in the treatment of herpes simplex infection requires great caution.

Bacterial Infections: Use of corticosteroids may suppress the host response and thus aid in the establishment of secondary ocular infections. Acute purulent infections of the eye may be masked or exacerbated by the presence of steroid medication.

Fungal Infections: Fungal infections of the cornea are particularly prone to develop coincidentally with long-term local steroid application. Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use.

Contamination: Do not touch dropper tip to any surface as this may contaminate the suspension.

Contact Lens Wear: Contact lenses should be removed during instillation of FLAREX but may be reinserted after 15 minutes.

Temporarily Blurred Vision: Vision may be temporarily blurred following dosing with FLAREX. Care should be exercised in operating machinery or driving a motor vehicle.

ADVERSE REACTIONS

Glaucoma with optic nerve damage, visual acuity and field defects, cataract formation, secondary ocular infection following suppression of host response, and perforation of the globe may occur.

Postmarketing Experience: The following reaction has been identified during postmarketing use of FLAREX in clinical practice. Because reactions are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. The reaction, which has been chosen for inclusion due to either its seriousness, frequency of reporting, possible causal connection to FLAREX, or a combination of these factors, includes dysgeusia.

Please see the Full Prescribing Information.

Reference: 1. Data on file. Fort Worth, TX: Eyevance Pharmaceuticals LLC.

INDICATIONS AND USAGE

FLAREX® (fluorometholone acetate ophthalmic suspension) is indicated for use in the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the eye.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

Contraindicated in acute superficial herpes simplex keratitis, vaccinia, varicella, and most other viral diseases of the cornea and conjunctiva; mycobacterial infection of the eye; fungal diseases; acute purulent untreated infections, which like other diseases caused by microorganisms, may be masked or enhanced by the presence of the steroid; and in those persons who have known hypersensitivity to any component of this preparation.

WARNINGS AND PRECAUTIONS

Topical Ophthalmic Use Only: Not for injection.

Intraocular Pressure Increase: Prolonged use may result in glaucoma, damage to the optic nerve, and defects in visual acuity and visual field. It is advisable that the intraocular pressure be checked frequently.

Cataracts: Use of corticosteroids may result in cataract formation.

Delayed Healing: Topical ophthalmic corticosteroids may slow corneal wound healing. In those diseases causing thinning of the cornea or sclera, perforation has been known to occur with chronic use of topical steroids.

Viral Infections: Use in the treatment of herpes simplex infection requires great caution.

Bacterial Infections: Use of corticosteroids may suppress the host response and thus aid in the establishment of secondary ocular infections. Acute purulent infections of the eye may be masked or exacerbated by the presence of steroid medication.

Fungal Infections: Fungal infections of the cornea are particularly prone to develop coincidentally with long-term local steroid application. Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use.

Contamination: Do not touch dropper tip to any surface as this may contaminate the suspension.

Contact Lens Wear: Contact lenses should be removed during instillation of FLAREX but may be reinserted after 15 minutes.

Temporarily Blurred Vision: Vision may be temporarily blurred following dosing with FLAREX. Care should be exercised in operating machinery or driving a motor vehicle.

ADVERSE REACTIONS

Glaucoma with optic nerve damage, visual acuity and field defects, cataract formation, secondary ocular infection following suppression of host response, and perforation of the globe may occur.

Postmarketing Experience: The following reaction has been identified during postmarketing use of FLAREX in clinical practice. Because reactions are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. The reaction, which has been chosen for inclusion due to either its seriousness, frequency of reporting, possible causal connection to FLAREX, or a combination of these factors, includes dysgeusia.

Please see the Full Prescribing Information.