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 Your Treatment - Request a Rebate

Request a rebate of up to $30 by providing the
information below.

Print your rebate coupon after completing the form below. Only 1 rebate per customer. See additional terms and conditions below. Coupon valid for Commercial and cash-pay patients only.
Individual plans and out-of-pocket costs vary.

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Offer not valid for prescriptions reimbursed or paid under Medicare, Medicaid, or any similar federal or state healthcare program, including any state medical or pharmaceutical assistance programs. Offer also voided where prohibited by law, taxed, or restricted. Amount of rebate not to exceed $25 for COMBIGAN® or co-pay, whichever is less. This certificate may not be reproduced and must accompany your request for a rebate. Offer good only for one prescription of COMBIGAN® per patient, per year, and only in the USA. Allergan, Inc., reserves the right to rescind, revoke, and amend this offer without notice. You are responsible for reporting receipt of rebate to any private insurer that pays for or reimburses you for any part of the prescription filled using this coupon.

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Indication: COMBIGAN® (brimonidine tartrate/timolol maleate ophthalmic solution) 0.2%/0.5% is approved for reducing elevated intraocular pressure (IOP) in patients with glaucoma who require additional or adjunctive IOP lowering therapy. COMBIGAN® lowers IOP slightly less than taking both brimonidine tartrate three times a day and timolol maleate two times a day.

IMPORTANT SAFETY INFORMATION

Contraindications: COMBIGAN® ophthalmic solution should not be used by patients who have, or ever had bronchial asthma, chronic bronchitis, emphysema, slow heartbeat, impaired conduction of the heart, heart failure, or impaired pumping of the heart. COMBIGAN® should not be used in patients under the age of 2 years, or by patients with hypersensitivity to any ingredient of this product.

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