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 Your Treatment - Request a Rebate

Request a rebate of up to $25 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 may vary.

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You are not eligible for the coupon if you are enrolled in any government, state, or federally funded prescription benefit program. This includes Medicare, Medicaid, Medigap, VA, DOD, and TriCare as well as any other state or federal employee benefit programs.

Offer is void 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 or ocular hypertension who require adjunctive or replacement therapy due to inadequately controlled IOP. COMBIGAN® lowers IOP slightly less than taking both brimonidine tartrate three times a day and timolol maleate two times a day.

Contraindications: COMBIGAN® ophthalmic solution should not be used by patients who have or ever had a reactive airway disease including 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 aged 2 years and younger, or by patients with hypersensitivity to any ingredient in this product.

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