$50

Cyclosporine 0.1%
BAK Free

To E-Scribe send NDC 71384-0514-05 to NCPDP 4612479


To order by fax, download this form, fill and fax.

$40

Dorzolamide 2%/Timolol 0.5%
BAK Free

To E-Scribe send NDC 24208-0486-10 to NCPDP 4612479, must add comment "Compound BAK Free"

To order by fax, download this form, fill and fax.

Drug Strength Quantity Price (with fuctioning coupon)
ALREX 0.2% 5ML, 10ML $75, $115
BEPREVE 1.5% 5ML, 10ML $75, $115
BESIVANCE 0.6% 5ML $75
BRIMONIDINE 0.2% 5ML $16
CIPROFLOXACIN 0.3% 5ML $20
COSOPT PF 60 Single Use Vials $170
CYCLOPENTOLATE 1% 2ML $22
DOROZOL/TIMOLOL 10ML $20
DORZOLOMIDE/
TIMOLOL CMPD
2%/0.5% 5ML $40
DORZOLAMIDE 2% 10ML $30
ERYTHROMYCIN OINT 0.5% 3.5G $30
FLUOROMETHOLONE 0.1% 5ML $85
GATIFLOXACIN 0.5% 2.5ML $85
KETOROLAC 0.5% 5ML $20
LATANOPROST 0.005% 2.5ML $17
LOTEMAX SM 0.5% 5ML $75
LOTEMAX GEL 0.5% 5ML $75
LOTEMAX OINT 1% 5 $75
MOXIFLOXACIN 0.5% 3ML $55
OFLOXACIN 0.3% 5ML $35
PAZEO 0.7% 2.5ML $100 off copay
POLYMYXIN/TMP 10ML $20
PREDNISOLONE 1% 5ML $60
PROLENSA 0.07% 3ML $75
RESTASIS 0.05% 60 Single Use VIALS $255 off copay
RESTASIS 0.05% 30 Day Multi-Dose VIALS $250 off copay
RHOPRESSA 0.02% 2.5ML $50
TIMOLOL 0.5% 5ML, 10ML, 15ML $15, $30, $45
TIMOPTIC 0.5% 60 Single Use VIALS $75
TOBRAMYCIN 0.3% 5ML $20
VYZULTA 0.24% 5ML $120
XIIDRA 5% 60 Single Use VIALS $250 off copay
ZYLET 0.3-0.5% 5ML, 10ML $75, $115
Prices listed are estimates only and not a guarantee of pricing or eligibility. Coupon eligibility is subject to the terms and conditions specific to the drug coupon, restrictions may apply. Patient Pay amounts without a coupon are subject to insurance coverage or participation in the Meds In Motion Rewards Loyalty Program and are not a reflection of usual and customary pricing. Meds In Motion cannot alter or waive copay amounts from insurance companies. Coupon coverage and patient pay amounts may change at any time without prior notice. Coupon coverage may vary from instance to instance depending on patient insurance coverage. Coupon cards are not health insurance. Participation in the Meds In Motion Rewards Loyalty Program is not health insurance. Coupons cannot be used for claims covered by Medicare, Medicaid, or any other federal or state program.
Price list as of 2/27/20. Prices subject to change.

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