You are using an outdated browser. Please upgrade your browser to improve your experience and security.

Skip to content

Copay Savings Program

Eyevance® is committed to helping all patients have affordable access to ZERVIATE™

Pay as little as $45

For patients for whom ZERVIATE is covered by commercial insurance.a

OR

Pay as little as $45

For patients for whom ZERVIATE is not covered by commercial insurance, Medicare Part D, or Medicare Advantage.a

aTo the Patient: You must activate and present this card to the pharmacist with a valid prescription to participate in this program. If you have questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the Eyevance Copay Savings Program at 866-747-0976 (8:00 am8:00 pm EST, Monday–Friday). For patients whose ZERVIATE prescriptions are covered by commercial insurance, use of this card may reduce your copayment responsibility to as little as $45. For patients whose ZERVIATE prescriptions are not covered by either commercial or government insurance, use of this card may reduce your cost for ZERVIATE to as little as $45. This program is subject to overall maximum support amounts and is valid for up to 4 prescriptions. This coupon is not valid for prescriptions paid for in part or full under any state or federally funded program, such as but are not limited to Medicaid, VA, DOD, or Tricare, including any state prescription drug assistance programs. Patients who have prescription drug coverage under Medicare Part D or Medicare Advantage may take advantage of this offer, provided that they acknowledge that by doing so they will not seek any prescription coverage or reimbursement from their insurer for the cost of ZERVIATE, or report any amounts paid for ZERVIATE as part of their “true out-of-pocket expenses” under Medicare Part D or Medicare Advantage. When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions, and that you have responded truthfully to questions when activating the card. This offer expires on 12/31/20.

To the Pharmacist: When you process this card, you are certifying that you have read, understood, and are in compliance with the terms and conditions pertaining to this program. You are further certifying that you have not submitted and will not submit a claim for reimbursement under Medicare Part D or similar federal or state programs, including any state medical pharmaceutical assistance program for this prescription.

  • Submit transaction to McKesson Corporation using [BIN #610524].
  • If primary commercial prescription insurance exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
  • Acceptance of this card and your submission of claims for the Eyevance Copay Savings Program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc.
  • The LoyaltyScript® card is not valid for use with any other prescription drug discount or cash cards for ZERVIATE. Claims submitted utilizing the program are subject to audit or validation.
  • For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for Eyevance Copay Savings Program at 866.747.0976 (8:00 am8:00 pm EST, Monday–Friday).

Eyevance reserves the right to rescind, revoke, or amend this offer at any time.

COB=coordination of benefits; NCPDP=National Council for Prescription Drug Programs.

INDICATIONS AND USAGE

ZERVIATE™ (cetirizine ophthalmic solution) 0.24% is a histamine-1 (H1) receptor antagonist indicated for treatment of ocular itching associated with allergic conjunctivitis.

DOSAGE AND ADMINISTRATION

Instill one drop of ZERVIATE in each affected eye twice daily (approximately 8 hours apart).

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

Contamination of Tip and Solution: As with any eye drop, care should be taken not to touch the eyelids or surrounding areas with the dropper tip of the bottle or tip of the single-use container to avoid injury to the eye and to prevent contaminating the tip and solution. Keep the multi-dose bottle closed when not in use. Discard the single-use container after using in each eye.

Contact Lens Wear: Patients should be advised not to wear a contact lens if their eye is red. ZERVIATE should not be instilled while wearing contact lenses. Remove contact lenses prior to instillation of ZERVIATE. The preservative in ZERVIATE, benzalkonium chloride, may be absorbed by soft contact lenses. Lenses may be reinserted 10 minutes following administration of ZERVIATE.

ADVERSE REACTIONS

The most commonly reported adverse reactions occurred in approximately 1%–7% of patients treated with either ZERVIATE or vehicle. These reactions were ocular hyperemia, instillation site pain, and visual acuity reduced.

Please see the Full Prescribing Information.

INDICATIONS AND USAGE

ZERVIATE™ (cetirizine ophthalmic solution) 0.24% is a histamine-1 (H1) receptor antagonist indicated for treatment of ocular itching associated with allergic conjunctivitis.

DOSAGE AND ADMINISTRATION

Instill one drop of ZERVIATE in each affected eye twice daily (approximately 8 hours apart).

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

Contamination of Tip and Solution: As with any eye drop, care should be taken not to touch the eyelids or surrounding areas with the dropper tip of the bottle or tip of the single-use container to avoid injury to the eye and to prevent contaminating the tip and solution. Keep the multi-dose bottle closed when not in use. Discard the single-use container after using in each eye.

Contact Lens Wear: Patients should be advised not to wear a contact lens if their eye is red. ZERVIATE should not be instilled while wearing contact lenses. Remove contact lenses prior to instillation of ZERVIATE. The preservative in ZERVIATE, benzalkonium chloride, may be absorbed by soft contact lenses. Lenses may be reinserted 10 minutes following administration of ZERVIATE.

ADVERSE REACTIONS

The most commonly reported adverse reactions occurred in approximately 1%–7% of patients treated with either ZERVIATE or vehicle. These reactions were ocular hyperemia, instillation site pain, and visual acuity reduced.

Please see the Full Prescribing Information.