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Part D Program

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If your Medicare prescription drug insurance does not cover LOTEMAX® SM, LOTEMAX® Ointment, LOTEMAX® Gel (loteprednol etabonate ophthalmic gel) 0.5%, PROLENSA® or ZYLET®, or your out-of-pocket costs exceed $80* under that insurance, Bausch + Lomb may be able to help.

*Terms, conditions and limitations apply. Most eligible patients may pay as little as $80. See Eligibility Criteria/Terms and conditions below.

To activate your card or enroll for a card, please answer the following questions:

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Eligibility Criteria/Terms and Conditions

The Part D Program is valid for a cost reduction of a qualifying prescription of LOTEMAX® SM (loteprednol etabonate ophthalmic gel) 0.38%, LOTEMAX® Ointment (loteprednol etabonate ophthalmic ointment) 0.5%, LOTEMAX® Gel (loteprednol etabonate ophthalmic gel) 0.5%, PROLENSA® (bromfenac ophthalmic solution) 0.07%, or ZYLET® (loteprednol etabonate 0.5% and tobramycin 0.3% ophthalmic suspension) for eligible patients.

  • The Part D Program reduces most eligible patients’ out-of-pocket cost to as little as $80 per each prescription, even if the patient uses the program for more than one prescription.
  • You must have prescription drug insurance through a Medicare Part D or a Medicare Advantage prescription drug plan.
  • Patients participating in Medicare Part D or a Medicare Advantage prescription drug plan who are eligible to use the Part D Program must agree to the following conditions:
    • The patient must agree to not seek reimbursement from their Medicare or Medicare Advantage prescription plan for their out-of-pocket costs for the prescriptions purchased with the Part D Program.
    • The patient must also agree not to count the cost of the prescriptions toward their deductible or true out-of-pocket cost.
    • The patient must notify prescription plan that LOTEMAX® SM, LOTEMAX® Ointment, LOTEMAX® Gel, PROLENSA® or ZYLET® has been purchased outside of benefit by sending the form letter provided with this card.
    • The patient is responsible for all additional costs and expenses after reimbursement limits are reached.
    • The patient must purchase all prescriptions with the Part D Program and must not use Medicare Part D benefit.
  • The Part D Program is not valid for any patients with commercial/private insurance, uninsured patients, or patients with prescription coverage under any other federal or state health program such as Medicaid or TRICARE.
  • No other purchase necessary.
  • The Part D Program is not transferable. No substitutions are permitted. Cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer not already associated with this program.
  • The Part D Program is not insurance.
  • The Part D Program can be used at mail order pharmacies.
  • The Part D Program card is the property of Bausch + Lomb and must be turned in on request.
  • It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Part D Program card. Void if reproduced. Void where prohibited by law, taxed, or restricted.
  • The Part D Program can be used only by eligible United States residents (including Puerto Rico, Guam and the US Virgin Islands) at participating eligible retail pharmacies in the United States. Product must originate from the United States.
  • The Part D Program is not valid for redemption in the State of Massachusetts or by any resident of the State of Massachusetts with regard to any product for which a therapeutically equivalent generic product is available including, but not limited to, LOTEMAX® Gel and PROLENSA®.
  • Bausch + Lomb reserves the right to rescind, revoke, or amend the Part D Program at any time without notice.
  • For questions call: 1-800-795-1091.