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`Save up to $1300 on your TRAVATAN Z Solution Refills*
`Pay no more than $25 for each 30day supply of TRAVATAN Z® Solution
`through March 2013
`If you've been prescribed TRAVATAN Z® Solution, sign up for the Openings™ Patient Support
`Program today for useful tips, helpful reminders and an opportunity to save money on your
`prescription.
`
`You'll receive a welcome kit in the mail that includes our savings card — which makes it a little
`easier to stay on track with your TRAVATAN Z® Solution prescription. Here's how:
`If you fill your prescription every month, Alcon will pay up to $100 after your copay or outof
`pocket costs over $25 for each 30day supply. If you get 12 bottles per year (one each
`month), your savings can amount to as much as $1,200. If you fill your prescription every 3
`months, Alcon will pay up to $325 after your copay or outofpocket costs over $50 for each
`90day supply. If you get a 3bottle refill, your outofpocket cost would be less than $17 per
`month. Your savings can amount toas much as $1,300 with the 90day supply.
`So, for instance, let's say the pharmacist tells you that you owe $75 for your prescription
`after accounting for any private insurance you may have, you will be responsible for $25 of
`the total, and the OPENINGS™ Patient Support Program will cover the rest (a $50 savings).
`Click here for savings information if you get your prescription from mail order.
`
`*Click here for Rebate
`Terms and Conditions.
`
`Sign up for your savings card and other support materials from the
`OPENINGS Patient Support Program here.
`
`Complete this form to request your savings card
`
`Save up to $1300 on TRAVATAN Z® Solution when you
`join the Openings™ Patient Support Program.*
`
`TravatanZ
`Solution
`
`*Required Fields
`
`Check all boxes that apply.
`†1. Have you been diagnosed with any of these ocular conditions?
`† Name
`INDICATIONS AND USAGE
`High eye pressure
`Primary openangle glaucoma
`TRAVATAN Z® (travoprost ophthalmic solution) 0.004% is a prescription medicine indicated for the reduction of elevated intraocular pressure
`†Address
`Ocular hypertension
`Other
`(IOP) in patients with openangle glaucoma or ocular hypertension.
`Dosage and Administration
`†City
`†2. Are you currently taking TRAVATAN Z® Solution?
`The recommended dosage of TRAVATAN Z® Solution is one drop in the affected eye(s) once a day, in the evening.
` Select one
`†State
`Yes
`No
`IMPORTANT SAFETY INFORMATION
`†Zip
`YES, send me my Savings Card and sign me up for
`Warnings and Precautions
`other helpful materials from the Openings™ Patient
`Pigmentation
`Support Program. I prefer:
`Some patients may experience darkening of the iris (the colored part of the eye) which is most noticeable in patients who only receive
`Phone
`email
`regular mail
`treatment in one eye. These changes may be permanent.
`Eyelash Changes
`Patients may also experience growth and thickening of their eyelashes, and/or darkening of the skin around the eye. These changes are
`Your information will only be used to fulfill your request. Your information
`usually reversible.
`will not be shared with other companies or organizations.
`
`Adverse Reactions
`The most common side effect with TRAVATAN Z® Solution is redness of the eye (also known as ocular hyperemia). Other side effects include
`eye discomfort, a feeling of something in the eye, eye pain and itching.
`*Click here for Rebate Terms and Conditions.
`Use in Specific Populations
`Use in pediatric patients below the age of 16 years is not recommended because of potential safety concerns related to increased
`pigmentation following longterm chronic use.
`How to redeem your savings if you get your prescriptions from mail order.
`You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1800FDA
`1088.
`
`Click here for the full prescribing information.
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`Copyright © 2011 Novartis, The information and materials within this section pertain to the U.S. market only. Not all products are approved in
`every market and approved labeling and instructions may vary by local country. For market specific product information, see the locations
`section of this website. See Alcon Privacy Policy and Terms & Conditions for the use of this site.
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`Help
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`Most mail order facilities do not accept savings cards because they are unable to process them.
`
`But you can still take advantage of the savings on your prescriptions of TRAVATAN Z® Solution filled by mail order by following these
`steps:
`Start by asking your mail order facility if they accept the card.
`If not, collect the following information:
`The 11digit ID# and GRP# that are found in the lower left hand corner of your card;
`if you prefer, you can make a photocopy of the front of the card instead
`Your original receipt (which should include the mail order pharmacy name, product name, prescription number or Rx#, date filled, quantity,
`and price you paid)
`A card with your name, address, city, state, zip code, phone number, and the amount of money you paid for your prescription (your “out of
`pocket” expense)
`Mail all of this information to:
`TRAVATAN Z® Solution Savings Program
`PO Box 7017
`Bedminster, NJ 07921
`For questions regarding this process, please call 8668752455.
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`Explore this website by clicking on any of the titles at
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`http://web.archive.org/web/20120210013546/http://www.travatanz.com/glaucomamedicine.aspx
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