PATANASE® Nasal Spray Product Rebate
Thank you for registering for the PATANASE® Nasal Spray Product Rebate
Please allow 10 weeks for your rebate to be processed
- Present your prescription for PATANASE® Nasal Spray to your pharmacy.
- Pay your applicable out of pocket costs and keep your receipt.
- Fill out the required fields below and click "Submit" to generate your rebate form.
- Print and sign the rebate form.
- If you are eligible for this rebate (see the complete Terms and Conditions below), mail this form and your original dated cash register receipt to the address shown.
This offer expires on 3/31/14. Rebate requests must be postmarked by 4/30/14.
Please confirm that your name and contact information are correct.
|City, State, ZIP:||,|
I certify that I have reviewed the rebate Terms and Conditions printed below, and that I am eligible for this rebate offer.
PATANASE® Nasal Spray Online Rebate
PO Box 540007
El Paso, TX 88554-0007
You'll receive your rebate within 8 weeks. Visit our rebate status page for information on checking your rebate status.
Rebate Terms and Conditions
- This offer applies to your out of pocket expenses for PATANASE® Nasal Spray. Patients will be reimbursed for actual out-of-pocket expense for a PATANASE® Nasal Spray prescription up to $10.
- By accepting this offer, you certify that acceptance of the offer is consistent with the terms of your insurance plan and that you will report the value received under this offer to any health insurer or third party paying for any part of the prescription if you are required to do so by benefit terms, contract, or law.
- This offer is not valid for patients who receive prescription drug benefits through Medicare Part D, Medicaid, Medigap, VA, DOD, Tricare, or any comparable government-run pharmaceutical assistance program.
- The rebate form must be accompanied by an original dated pharmacy receipt for PATANASE® Nasal Spray. Make a copy of your submission for your records.
- This offer expires on 3/31/14. Rebate requests must be postmarked by 4/30/14.
- The rebate form and the original proof of purchase must accompany the request. Rebate materials will not be returned.
- Incomplete or illegible requests will not be honored. Sponsor is not responsible for lost, late, mutilated, misdirected or postage-due mail and/or requests.
- Please allow 8 weeks for delivery. Sponsor is not responsible for lost or stolen reimbursement payments.
- If you have not received your rebate after 8 weeks, please call 1-855-785-6630 or visit alconrebates.com to check on the status of your rebate.
- This offer is good only in the United States. The offer may not be combined with any other rebate, discount, free trial, or other similar offer for the same prescription. This offer is not health insurance. This offer is subject to applicable state and federal law and is not valid where prohibited by law.
- Alcon reserves the right to rescind, revoke or amend this offer without notice at any time.
- We will use your email address to communicate with you the status of your rebate.
®2013 Novartis 4/13 PTN13018RB