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For adults with open-angle glaucoma or ocular hypertension
insured patients are covered for Rhopressa®.2*
“Insured” includes Commercial, Medicare Part D, Managed Medicaid, Health Exchanges, and State Medicaid.
30-day supply
$25
per month
90-day supply
$8.33
per month
That’s less than $9 per month for a 90-day prescription
†Restrictions apply. Patients with federal or state prescription coverage, such as Medicare or Medicaid, are not eligible.
Download the Rhopressa® Savings Card and instruct patients to present it to the pharmacist with their prescription.
Patient Instructions: In order to redeem this offer you must have a valid prescription for ROCKLATAN® or RHOPRESSA®. This offer may not be redeemed for cash. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described in the Restrictions section below. Patients who are enrolled in a state or federally funded prescription insurance program, such as Medicare or Medicaid, are excluded. Patients with questions about the ROCKLATAN® or RHOPRESSA® Savings offer should call 1-844-807-9706.
Eligible commercially insured patients may pay as little as $25 per 30-day, 60-day, or 90-day supply. Patient pay amount may vary dependent upon commercial insurance coverage for ROCKLATAN® or RHOPRESSA®. Maximum savings limit applies; patient out-of-pocket expense may vary. Offer valid up to 12-month qualifying prescriptions.
Pharmacist instructions: Submit the claim to the primary commercial insurance company first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code (OCC). For eligible commercial patients, submit BIN and OCC 08. For eligible commercial patients when the product is not covered, submit BIN and OCC 03.
For any questions regarding CHANGE HEALTHCARE online processing, please call the Help Desk at 1-800-433-4893.
Restrictions: This offer is valid for eligible residents of the United States only. This offer is void in U.S. territories including, but not limited to, Puerto Rico. Offer not valid for prescriptions reimbursed under Medicare, a Medicaid drug benefit plan, TRICARE, CHAMPUS or other federal or state health programs. Offer may not be combined with any savings, discount card, trial or similar offer for the same prescription. No other purchase is necessary. Coupon is not insurance. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payor of the existence and/or value of this offer. Offer not valid for patients under 18 years of age. It is illegal to (or offer to) sell, purchase, trade, reproduce or counterfeit this offer. This offer is not transferable. Void where prohibited by law. This offer will expire on March 1, 2023. Program managed by ConnectiveRx on behalf of Aerie Pharmaceuticals, Inc. Aerie Pharmaceuticals, Inc. reserves the right to rescind, revoke or amend this offer without notice at any time.
BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.
Bacterial Keratitis: There have been reports of bacterial keratitis associated with the use of multiple-dose containers of topical ophthalmic products. These containers had been inadvertently contaminated by patients who, in most cases, had a concurrent corneal disease or a disruption of the ocular epithelial surface.
Contact Lenses: Contact lenses should be removed prior to instillation of Rhopressa® and may be inserted 15 minutes following its administration.
The most common ocular adverse reaction observed in controlled clinical studies with Rhopressa® dosed once daily was conjunctival hyperemia, reported in 53% of patients. Six percent of patients discontinued therapy due to conjunctival hyperemia. Other common (approximately 20%) adverse reactions were: corneal verticillata, instillation site pain, and conjunctival hemorrhage. Instillation site erythema, corneal staining, blurred vision, increased lacrimation, erythema of eyelid, and reduced visual acuity were reported in 5-10% of patients.
The corneal verticillata seen in Rhopressa®- treated patients were first noted at 4 weeks of daily dosing. This reaction did not result in any apparent visual functional changes. Most corneal verticillata resolved upon discontinuation of treatment.
Please click here for full prescribing information for Rhopressa®.
You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Rhopressa® (netarsudil ophthalmic solution) 0.02% is indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension.
The recommended dosage is one drop in the affected eye(s) once daily in the evening.
Bacterial Keratitis: There have been reports of bacterial keratitis associated with the use of multiple-dose containers of topical ophthalmic products. These containers had been inadvertently contaminated by patients who, in most cases, had a concurrent corneal disease or a disruption of the ocular epithelial surface.
Contact Lenses: Contact lenses should be removed prior to instillation of Rhopressa® and may be inserted 15 minutes following its administration.
The most common ocular adverse reaction observed in controlled clinical studies with Rhopressa® dosed once daily was conjunctival hyperemia, reported in 53% of patients. Six percent of patients discontinued therapy due to conjunctival hyperemia. Other common (approximately 20%) adverse reactions were: corneal verticillata, instillation site pain, and conjunctival hemorrhage. Instillation site erythema, corneal staining, blurred vision, increased lacrimation, erythema of eyelid, and reduced visual acuity were reported in 5-10% of patients.
The corneal verticillata seen in Rhopressa®- treated patients were first noted at 4 weeks of daily dosing. This reaction did not result in any apparent visual functional changes. Most corneal verticillata resolved upon discontinuation of treatment.
Please click here for full prescribing information for Rhopressa®.
You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Rhopressa® (netarsudil ophthalmic solution) 0.02% is indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension.
The recommended dosage is one drop in the affected eye(s) once daily in the evening.
References: