•Eligible commercially insured patients may pay as little as $0 out of pocket
•Maximum Program assistance per prescription and annual benefits apply and outofpocket expenses may vary; patient is responsible for costs above maximum benefit amounts
•Limit one program enrollment per individual
•Valid only for Teva’s Alvaiz, NDC: 00480327356, 00480327456, 00480327556, and 00480327656
•For questions regarding processing, please call the Help Desk at 8442487949