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Full Prescribing Information, including Boxed Warning

ELIGIBLE PATIENTS MAY
PAY AS LITTLE AS
$25^†
PER 1-MONTH OR 3-MONTH
PRESCRIPTION FILL

You may be eligible^† for savings.
Sign-up is easy. Start now!

See full Prescribing Information, including Boxed Warning.

^†Depending on insurance coverage, eligible patients may pay as little as $25 for each of up to 13 one-month Taytulla^® prescription fills OR each of up to 4 three-month Taytulla^® prescription fills. Check with your pharmacist for your copay discount. Maximum savings limits apply; patient out-of-pocket expense will vary. Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs. See Program Terms, Conditions, and Eligibility Criteria.

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Date of birth (mm/dd/yyyy)*

Email address*

By providing your email address above, you agree and acknowledge that you would like to receive email communications from Allergan related to Taytulla^® and the Taytulla^® Savings Program, including site updates, patient education, as well as other Allergan products and services. The information pertaining to you that we collect will be used in accordance with our Privacy Statement. If you later wish to stop receiving certain communications, you may unsubscribe by clicking on the link provided in future emails.

I agree, and I certify that the information I have provided about myself is complete and accurate.*

Please answer the following questions:

Do you live in the United States or Puerto Rico?*

Yes

Do you have commercial prescription drug insurance? (If you have Medicaid, Medicare, or other government-sponsored prescription insurance, such as VA/DOD, select "No".)*

Yes

By activating your Taytulla^® Savings Offer, you certify that the answers you have provided are true and correct and that you are not enrolled in a federal- or state-funded prescription drug benefit program, such as Medicare, Medicaid, or any private indemnity or HMO insurance plan that reimburses you for the entire cost of your prescription drugs. You also certify that you are not Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. You further certify that should you begin receiving prescription benefits from one of these types of programs at any time, you will no longer be eligible to participate in this savings program.

I agree to this certification, and I have read and accept the Program Terms, Conditions, and Eligibility Criteria.*

If you have any questions about the Taytulla^® Savings Program, please call 1.855.439.2817.

Allergan^® and its design are trademarks of Allergan, Inc.

Taytulla^® and its design are registered trademarks of Allergan Pharmaceuticals International Limited.

All other trademarks and product names are the property of their respective owners.

MBD124965 06/19

This site is intended for U.S. consumers only.

Savings Program Update