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SIGN UP FOR XIIDRA SAVINGS

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Xiidra Savings Program
Terms & Conditions:

Limitations apply. Valid for patients with private (commercial) insurance only. The Xiidra Co-pay Card Program includes the Co-pay Card and rebate. Eligible, commercially insured patients using the Co-pay Card pay $0 for their first prescription of Xiidra. $0 first fill available for prescriptions up to 90 days. After the first fill, eligible, commercially insured patients may pay as little as $0 for prescriptions of Xiidra, subject to a maximum monthly savings of $250 for each 30-day prescription and $750 for each 90-day prescription. Patient is responsible for any costs once monthly savings limit is reached. Program not valid (i) under Medicare, Medicaid, TRICARE, VA, DoD, or any other federal or state health care program, (ii) where patient is not using insurance coverage at all, or (iii) where the patient's insurance plan reimburses for the entire cost of the drug. The value of this program is exclusively for the benefit of patients and is intended to be credited towards patient out-of-pocket obligations and maximums, including applicable co-payments, coinsurance, and deductibles. Program is not valid where prohibited by law. Patient may not seek reimbursement for the value received from this program from other parties, including any health insurance program or plan, flexible spending account, or health care savings account. Patient is responsible for complying with any applicable limitations and requirements of their health plan related to the use of the Program. Valid only in the United States and Puerto Rico. This Program is not health insurance. Program may not be combined with any third party rebate, coupon, or offer. Proof of purchase may be required. Novartis reserves the right to rescind, revoke, or amend the Program and discontinue support at any time without notice.

11/21 141205

SIGN UP FOR
XIIDRA SAVINGS

Next, let's make sure you're eligible. Please fill in the information below. Items marked with (*) are required.

Are you a resident of the United States?*

How about government insurance... is your prescription covered, in whole or in part, under any state or federal government program, including but not limited to Medicare, Medicaid, Medigap, VA, DoD, or TRICARE?*

Xiidra Savings Program
Terms & Conditions:

Limitations apply. Valid for patients with private (commercial) insurance only. The Xiidra Co-pay Card Program includes the Co-pay Card and rebate. Eligible, commercially insured patients using the Co-pay Card pay $0 for their first prescription of Xiidra. $0 first fill available for prescriptions up to 90 days. After the first fill, eligible, commercially insured patients may pay as little as $0 for prescriptions of Xiidra, subject to a maximum monthly savings of $250 for each 30-day prescription and $750 for each 90-day prescription. Patient is responsible for any costs once monthly savings limit is reached. Program not valid (i) under Medicare, Medicaid, TRICARE, VA, DoD, or any other federal or state health care program, (ii) where patient is not using insurance coverage at all, or (iii) where the patient's insurance plan reimburses for the entire cost of the drug. The value of this program is exclusively for the benefit of patients and is intended to be credited towards patient out-of-pocket obligations and maximums, including applicable co-payments, coinsurance, and deductibles. Program is not valid where prohibited by law. Patient may not seek reimbursement for the value received from this program from other parties, including any health insurance program or plan, flexible spending account, or health care savings account. Patient is responsible for complying with any applicable limitations and requirements of their health plan related to the use of the Program. Valid only in the United States and Puerto Rico. This Program is not health insurance. Program may not be combined with any third party rebate, coupon, or offer. Proof of purchase may be required. Novartis reserves the right to rescind, revoke, or amend the Program and discontinue support at any time without notice.

11/21 141205

What is Xiidra?

Xiidra is a prescription eye drop used to treat the signs and symptoms of dry eye disease.

Important Safety Information

Do not use Xiidra if you are allergic to any of its ingredients. Seek medical care immediately if you get any symptoms of an allergic reaction.

The most common side effects of Xiidra include eye irritation, discomfort or blurred vision when the drops are applied to the eyes, and an unusual taste sensation.

To help avoid eye injury or contamination of the solution, do not touch the container tip to your eye or any surface. If you wear contact lenses, remove them before using Xiidra and wait for at least 15 minutes before placing them back in your eyes.

It is not known if Xiidra is safe and effective in children under 17 years of age.

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.

For additional safety information, click here for Full Prescribing Information and Patient Information and discuss with your doctor.