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CIPRODEX® (ciprofloxacin 0.3% and dexamethasone 0.1%) Sterile Otic Suspension

Terms and Conditions: A patient is eligible for this promotion if their commercial health plan co-pay for CIPRODEX® Otic is more than $20 or if they have no prescription drug insurance coverage. Eligible patients will receive instant savings of up to $150 on out-of-pocket costs over $20. An eligible patient can use this discount card up to 3 times.

This offer is not valid for patients who are enrolled in Medicaid, Medicare, or other federal or state prescription drug benefits programs, including medical assistance programs. In addition, this office is not valid for patients who are Massachusetts residents.

Additional Terms and Conditions:
To the Patient: Present this discount card and your insurance card (if any) with your prescription for CIPRODEX® Otic at any participating pharmacy in the United States. When you use this discount card, you are certifying that you understand the program rules, regulations, and terms and conditions. In addition, you agree that you will not submit a claim for reimbursement to any federal or state prescription drug benefit program, and that you will disclose this offer to your private insurer, if you are required to do so.

Mail Order: If you purchase CIPRODEX® Otic, through a mail order pharmacy and they do not accept this voucher, call McKesson Corporation at 1-877-264-2400 and request a Direct Member Reimbursement (DMR) form.

To the Pharmacist: When you use this discount card, you are certifying that you have not submitted and will not submit a claim for reimbursement to any federal or state prescription drug benefit programs for this prescription. Submit transaction to McKesson Corporation using BIN # 610524. If primary coverage exists, input card information as secondary coverage (not to exceed the co-pay amount or $20, whichever is less) and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response. Uninsured cash-paying patients will receive a benefit of $20 off. Acceptance of this card and your submission of claims are subject to the Terms and Conditions posted at www.mckessoncom/mprstnc. For questions call McKesson help Desk at 1-877-264-2440 (8:00 AM to 8:00 PM ET, Monday – Friday).

This offer is valid only in the United States. This offer may not be combined with any other rebate, discounts, free trial, or other similar offer for the same prescription. Each voucher may be used by a single patient, but may be used for up to three prescriptions. This voucher will be accepted only at participating pharmacies. This voucher may not be redeemed for cash. This voucher is not health insurance. Alcon reserves the right to rescind, revoke or amend this offer without notice at any time. The use of this voucher is subject to applicable state and federal laws.

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