For a mail-order 3-month prescription, your total maximum savings may be $375 ($125 x 3) If your co-pay or out-of-pocket costs are no more than $125, you pay $0. 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. This Savings Offer may limit your prescription cost to $0, subject to a $125 maximum monthly benefit. This Savings Offer is available for a maximum savings of $1,500 per year ($125 per month x 12 months). By using this Savings Offer, eligible patients may receive a savings of up to $125 per fill off their co-pay or out-of-pocket costs. Eligible patients may pay a minimum of $0 per monthly prescription fill.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.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 value of this Savings Offer is limited to $125 per use or the amount of your co-pay, whichever is less.This Savings Offer is not valid for prescriptions that are reimbursed, in whole or in part, by Medicaid, Medicare, TRICARE, Veterans Affairs healthcare, or any other federal or state healthcare program (including any state prescription drug assistance program), or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”).XALATAN SAVINGS CARD TERMS AND CONDITIONSīy 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: XALATAN is a prescription medication for the treatment of high eye pressure/intraocular pressure (IOP) in people with open-angle glaucoma or ocular hypertension. intraocular pressure (IOP) in people with open-angle glaucoma or ocular hypertension. XALATAN is a prescription medication for the treatment of high eye pressure The most common side effects for XALATAN may include blurred vision, burning and stinging, eye redness, eye itching, the feeling of something in the eye, increased darkening of eye color, or irritation of the clear front surface of the eye. If more than one topical eye medication is used, the drugs should be administered at least five minutes apart.

Contact lenses can be reinserted 15 minutes following administration of XALATAN. Contact lenses should be removed prior to the administration of XALATAN. XALATAN contains benzalkonium chloride, which may be absorbed by contact lenses. There have been reports of bacterial keratitis associated with the use of multiple-dose containers of topical ophthalmic products. Color changes may increase as long as XALATAN is administered, and eye color changes are likely to be permanent. XALATAN may slowly cause darkening of the eye color, darkening of the eyelid and eyelashes, and increased growth and thickness of eyelashes. XALATAN is not recommended in patients with a known hypersensitivity to latanoprost, benzalkonium chloride, or any other ingredients in this product.

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