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Help Your Patients Save on Rocklatan®*

Eligible patients can reduce the cost of their prescription from the start with the Rocklatan® Savings Card.

  • Save on Rocklatan┬« Savings Card
  • Pay as little as $25*

    with eligible commercial insurance where Rocklatan® is covered

  • Pay as little as $50*

    with eligible commercial insurance where Rocklatan® is not covered

Download the Rocklatan® Savings Card and instruct patients to present it to the pharmacist with their prescription.

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

Contraindications

None.

Warnings and Precautions

  • Pigmentation changes
  • Eyelash changes
  • Intraocular inflammation
  • Macular edema
  • Herpetic keratitis
  • Bacterial keratitis
  • Contact lens wear

Adverse reactions

Rocklatan®: The most common ocular adverse reaction is conjunctival hyperemia (59%). Five percent of patients discontinued therapy due to conjunctival hyperemia. Other common ocular adverse reactions were: instillation site pain (20%), corneal verticillata (15%), and conjunctival hemorrhage (11%). Eye pruritus, visual acuity reduced, increased lacrimation, instillation site discomfort, and blurred vision were reported in 5-8% of patients.

Netarsudil 0.02%: Instillation site erythema, corneal staining, increased lacrimation and erythema of eyelid.

Latanoprost 0.005%: Foreign body sensation, punctate keratitis, burning and stinging, itching, increased pigmentation of the iris, excessive tearing, eyelid discomfort, dry eye, eye pain, eyelid margin crusting, erythema of the eyelid, upper respiratory tract infection/nasopharyngitis/influenza, photophobia, eyelid edema, myalgia/arthralgia/back pain, and rash/allergic reaction.

Please click here for full prescribing information for Rocklatan®.

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.

INDICATIONS AND USAGE

Rocklatan® (netarsudil and latanoprost ophthalmic solution) 0.02%/0.005% is approved for the reduction of elevated intraocular pressure (IOP) in patients 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. If one dose is missed, treatment should continue with the next dose in the evening. The dosage of Rocklatan® should not exceed once daily. Rocklatan® may be used concomitantly with other topical ophthalmic drug products to lower IOP. If more than one topical ophthalmic drug is being used, the drugs should be administered at least five (5) minutes apart.


IMPORTANT SAFETY INFORMATION

Contraindications

None.

Warnings and Precautions

  • Pigmentation changes
  • Eyelash changes
  • Intraocular inflammation
  • Macular edema
  • Herpetic keratitis
  • Bacterial keratitis
  • Contact lens wear

Adverse reactions

Rocklatan®: The most common ocular adverse reaction is conjunctival hyperemia (59%). Five percent of patients discontinued therapy due to conjunctival hyperemia. Other common ocular adverse reactions were: instillation site pain (20%), corneal verticillata (15%), and conjunctival hemorrhage (11%). Eye pruritus, visual acuity reduced, increased lacrimation, instillation site discomfort, and blurred vision were reported in 5-8% of patients.

Netarsudil 0.02%: Instillation site erythema, corneal staining, increased lacrimation and erythema of eyelid.

Latanoprost 0.005%: Foreign body sensation, punctate keratitis, burning and stinging, itching, increased pigmentation of the iris, excessive tearing, eyelid discomfort, dry eye, eye pain, eyelid margin crusting, erythema of the eyelid, upper respiratory tract infection/nasopharyngitis/influenza, photophobia, eyelid edema, myalgia/arthralgia/back pain, and rash/allergic reaction.

Please click here for full prescribing information for Rocklatan®.

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.

INDICATIONS AND USAGE

Rocklatan® (netarsudil and latanoprost ophthalmic solution) 0.02%/0.005% is approved for the reduction of elevated intraocular pressure (IOP) in patients 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. If one dose is missed, treatment should continue with the next dose in the evening. The dosage of Rocklatan® should not exceed once daily. Rocklatan® may be used concomitantly with other topical ophthalmic drug products to lower IOP. If more than one topical ophthalmic drug is being used, the drugs should be administered at least five (5) minutes apart.