My Savings Program

You can start saving on your XIIDRA prescriptions

Eligible commercially insured patients may pay as little as a

$0 Copay^*

*See Terms and Conditions below.

Already have a XIIDRA copay card?
ACTIVATE COPAY CARD
Need a XIIDRA copay card?
DOWNLOAD COPAY CARD

Are you 18 years or older?

Yes

Are your prescriptions reimbursed (in whole or in part) under any federal, state, or other governmental programs?
Government-sponsored plans include Medicare (Medicare Advantage Part A, B, and D), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, and any other federal or state healthcare program.

Yes

We’re sorry. Based on your response, you’re not eligible for the XIIDRA My Savings Program. See Terms and Conditions below.

VISIT XIIDRA.COM FOR MORE INFO

Activate a XIIDRA copay card

Download a XIIDRA copay card

All fields are required.

Copay Card Group Number

Please enter the copay card group number.

Copay Card ID Number

Please enter the copay card ID number.

First Name

Please enter a first name.

Last Name

Please enter a last name.

Date of Birth

Please select a date of birth.

Please enter a valid email address.

Mobile Phone

Please enter a phone number.

Zip Code

Please enter a zip code.

Would you like to receive a digital XIIDRA copay card, savings alerts, and refill reminders via text?

Message and data rates may apply. Message frequency varies. You can opt out of texting at any time by replying STOP. Text HELP for help. See Terms and Conditions, Mobile Terms and Conditions, and Privacy Policy.

Yes, opt me in.

No, I do not want to receive SMS alerts.

Please select an option.

I would like to learn more about XIIDRA and other Bausch + Lomb Products I allow Bausch + Lomb and its affiliates to contact me about health- and product-related information and offers regarding their products, like XIIDRA.

By clicking “ACTIVATE COPAY CARD,” you confirm that you read and understand the Eligibility Criteria, Terms and Conditions, Privacy Policy, and Legal Notice of the program set forth below and that you currently meet all eligibility criteria and will comply with the Terms and Conditions of the copay program.

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My Savings Program

You can start saving on your XIIDRA prescriptions

Activate a XIIDRA copay card

Download a XIIDRA copay card

All fields are required.

SMS Text Program Coming Soon