PATANOL® Rebate

Terms and Conditions

Alcon Patanol

Rebate Terms and Conditions

  • Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan or other federal or state programs (such as medical assistance programs). If you are eligible for drug benefits under any such program, you cannot receive this rebate. By submitting this rebate voucher, you agree that you will not submit a claim for the prescription to a government payor.
  • If any part of your prescription is paid for by a non-governmental third party payor, you attest to having disclosed this offer to your third party payor.
  • This certificate must be accompanied by an original dated cash register pharmacy receipt for PATANOL® solution (proof of purchase) and empty 5 mL carton. Keep a copy of your submission for your records.
  • Patients will be reimbursed for actual out-of-pocket expense for a PATANOL® solution prescription not to exceed $10.
  • This original certificate and the original proof of purchase may not be reproduced and must accompany this request.
  • You may obtain and use this rebate for each and every prescription for PATANOL® solution.
  • Rebate materials will not be returned.
  • Offer not extended to clubs, groups or organizations.
  • Offer good only in the U.S.A. Void where taxed, restricted, or prohibited by law.
  • Please allow 10 weeks for payment. Not responsible for lost or stolen checks.
  • If you have not received your rebate after 10 weeks, please call 1-888-258-4574 or visit www.alconrebates.com to check on the status of your rebate.
  • Before visiting alconrebates.com, please wait 45 days from the date you mailed your rebate. This will ensure that we have processed your rebate. If your rebate status has not appeared after this initial 45-day period, please contact us.
  • Offer expires 4/30/09.
  • Request must be postmarked by 5/15/09.
  • Fraudulent submission of multiple requests could result in federal prosecution under the U.S. Mail Fraud Statutes (18 USC, Sections 1341 and 1342).
  • Incomplete or illegible requests will not be honored. Not responsible for lost, mutilated, misdirected, or postage-due mail and/or requests.
  • By submitting this voucher you acknowledge that you understand and have complied with the rules of this offer.
    • For MA residents only:
    I certify that I have no prescription insurance of any kind.
    Patient Signature
  • Sponsor: Alcon, Inc., 6201 South Freeway, Fort Worth, Texas 76134.

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