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Savings and support to help patients start and stay on RYALTRIS®

RYALTRIS® Co-Pay Card
Your eligible patients can pay as little as $39 for RYALTRIS®

RYALTRIS® Savings Card

*Maximum value of $100 per bottle. The RYALTRIS® Savings Card is not Health Insurance. See below for Eligibility and Restrictions. Program maximums and Terms and Conditions apply. This offer may not be combined with GoodRx coupon. Maximum value of $200 per bottle. See reverse side of downloaded card for RYALTRIS® and GoodRx Savings Card Terms and Conditions.

RYALTRIS® is available through BlinkRx via EMR

Ryaltris®+BlinkRx
  • Reduce Pharmacy call-backs
  • Quick delivery and free shipping
  • Dedicated customer service

Terms and Conditions

TO THE PHARMACY:

  • Submit transaction using PDMI RxBIN# 610020, PCN: PDMI. Processor requires Valid Prescriber ID#, Patient Name, and DOB for claim adjudication.
  • If primary coverage exists, input card information as secondary coverage and transmit using the Coordination of Benefits (COB) fields with Other Coverage Code type 08 of the National Council for Prescription Drug Programs (NCPDP) transaction. If commercial primary coverage is rejected, please retry using the coverage code 03 of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
  • For cash-paying patients, input card information as primary coverage and transmit using the COB fields with Other Coverage Code type 00 or 01 of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
  • For pharmacy assistance filing this claim, please call the Pharmacy Help Desk at 1-833-404-5757. By using this card, you certify that the patient meets the eligibility requirements described below and that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental program for this prescription. As a condition of payment, you certify that you are in compliance with the terms, and conditions set forth herein, as well as with any obligations to provide notice of your participation in this savings program to third-party payers as required by law, contract, or otherwise.

TO THE PATIENT: Eligibility & Restrictions:

RYALTRIS SAVINGS CARD TERMS AND CONDITIONS:

You may be eligible if you are covered by commercial insurance, your insurance does not cover the full cost of the prescription, or you are a cash-paying patient. No other purchase is necessary. This offer is not Health Insurance. No substitutions permitted.

This card is not transferable. You are not eligible if you are enrolled in any state or federally funded healthcare program, including, but not limited to, Medicare, Medicare Part D, Medicaid (including Medicaid managed care), Medigap, VA, FEHB, DoD, TRICARE®, or a state pharmacy assistance program. In addition, this card can be redeemed only by patients or patient guardians who are 18 years or older and a legal resident of the US or Puerto Rico. Offer void where prohibited by law, taxed, or restricted. This offer may not be used with any other discount, trial offer, or other offer. Hikma Specialty USA Inc. reserves the right to rescind, revoke, or amend this program without notice. Participation in this program confirms that this offer is consistent with your insurance coverage, if any, and that you will report the value received if required by your insurance provider. By using this card, you certify that you understand and will comply with the terms and conditions. For questions, please contact uscustomerservice@hikma.com or call 1-800-631-2174. Other conditions may apply.

GOODRX SAVINGS CARD TERMS AND CONDITIONS:

GoodRx is NOT insurance. GoodRx has partnered with Hikma Pharmaceuticals to make the RYALTRIS Savings Card available to qualifying GoodRx users. The RYALTRIS Savings Card is not a GoodRx offer but may allow for additional savings depending on your insurance status and the RYALTRIS Savings Card Terms and Conditions.

If you do not qualify for the RYALTRIS Savings Card, check above to see if you are eligible to use the GoodRx coupon price instead.

DoD=US Department of Defense; FEHB=Federal Employees Health Benefits; PCN=Processor Control Number; VA=US Department of Veterans Affairs.

 

IMPORTANT SAFETY INFORMATION AND INDICATIONS1

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CONTRAINDICATIONS

IMPORTANT SAFETY INFORMATION AND INDICATIONS1

CONTRAINDICATIONS

Patients with known hypersensitivity to any ingredients of RYALTRIS, including mometasone furoate. (4)

WARNINGS AND PRECAUTIONS

  • Epistaxis, nasal ulcerations, nasal septal perforations, impaired wound healing, and Candida albicans infection: Monitor patients periodically for signs of adverse reactions on the nasal mucosa. (5.1)
  • Somnolence: Avoid engaging in hazardous occupations requiring complete mental alertness and motor coordination such as driving or operating machinery when taking RYALTRIS. (5.2)
  • Avoid concurrent use of alcohol or other central nervous system (CNS) depressants with RYALTRIS because additional reductions in alertness and additional impairment of CNS performance may occur. (5.2)
  • Glaucoma and cataracts: Monitor patients with a change in vision or with a history of increased intraocular pressure, glaucoma, and/or cataracts. (5.3)
  • Hypersensitivity Reactions: Hypersensitivity reactions can occur with RYALTRIS. Hypersensitivity reactions including wheezing, have occurred after the nasal administration of mometasone furoate. Discontinue RYALTRIS if such reactions occur. (5.4)
  • Immunosuppression and Risk of Infections: Potential worsening of existing tuberculosis; fungal, bacterial, viral, or parasitic infections; or ocular herpes simplex. More serious or even fatal course of chickenpox or measles in susceptible patients: Use caution in patients with the above because of the potential for worsening of these infections. (5.5)
  • Hypercorticism and adrenal suppression with misuse or use of higher-than-recommended dosages or at the regular dosage in susceptible patients at risk for such effects. (5.6)
  • Potential reduction in growth velocity in children: Routinely monitor the growth in pediatric patients receiving RYALTRIS. (5.7, 8.4)

ADVERSE REACTIONS

The most common adverse reactions (≥1% incidence) are dysgeusia, epistaxis, and nasal discomfort. (6.1)

INDICATIONS

RYALTRIS is a combination of olopatadine, a histamine-1 (H1)-receptor inhibitor, and mometasone furoate, a corticosteroid, indicated for the treatment of symptoms of seasonal allergic rhinitis in adult and pediatric patients 12 years of age and older.

For more information, please see the Full Prescribing Information.

To report an adverse event or product complaint, please contact us at us.hikma@primevigilance.com or call 1-877-845-0689 or 1-800-962-8364.

Adverse events may also be reported to the FDA directly at 1-800-FDA-1088 or https://www.fda.gov/medwatch.

RYALTRIS and the RYALTRIS logo are registered trademarks of Glenmark Specialty SA.

Distributed by: Hikma Specialty USA Inc. Columbus, OH 43228

Reference
  1. RYALTRIS® Nasal Spray approved prescribing information, Glenmark Specialty SA, Switzerland.

IMPORTANT SAFETY INFORMATION AND INDICATIONS1

Read More...

IMPORTANT SAFETY INFORMATION

IMPORTANT SAFETY INFORMATION AND INDICATIONS1

IMPORTANT SAFETY INFORMATION

  • Do not take RYALTRIS if you are allergic to olopatadine hydrochloride, mometasone furoate monohydrate or any of the ingredients in RYALTRIS. Ask your healthcare provider if you are not sure.
  • RYALTRIS can cause sleepiness or drowsiness. Do not drive, operate machinery or do anything that requires alertness until you know how RYALTRIS affects you.
  • Do not drink alcohol or take any other medicines that may cause you to feel sleepy while using RYALTRIS.

RYALTRIS may cause serious side effects, including the following:

  • Sleepiness or drowsiness.
  • Nose and throat problems. Symptoms of nose and throat problems may include: nosebleeds, sores (ulcers) in the nose, hole in the cartilage between your nose (nasal septal perforation). Symptoms of nasal septal perforation may include: crusting in the nose, nosebleeds, runny nose and/or a whistling sound when you breathe.
  • Slow wound healing. You should not use RYALTRIS until your nose has healed if you have a sore in your nose, if you have had surgery on your nose or if your nose has been injured.
  • Fungal infection in your nose and throat (thrush, or Candida). Tell your healthcare provider if you have any redness or white-colored patches in your nose or mouth.
  • Eye problems, including glaucoma or cataracts. You should have regular eye exams when using RYALTRIS.
  • Allergic reactions. Call your healthcare provider or get emergency medical care if you have any of the following signs of a serious allergic reaction: wheezing, rash, hives, swelling of your face, mouth, and tongue and breathing problems.
  • Immune system problems that may increase the risk of infection. Taking medicines that weaken your immune system makes you more likely to get infections. These infections may include tuberculosis (TB), ocular herpes simplex infections, and infections caused by fungi, bacteria, viruses, and parasites. Avoid contact with people who have contagious diseases, such as chickenpox or measles, while using RYALTRIS. If you come in contact with someone who has chickenpox or measles, call your healthcare provider right away. Symptoms of infection may include: fever, aches or pains, chills and tiredness.
  • Adrenal insufficiency. Adrenal insufficiency happens when your adrenal glands do not make enough steroid hormones. Symptoms of adrenal insufficiency can include: tiredness, weakness, nausea, vomiting and low blood pressure.
  • Slowed growth in children. A child’s growth should be checked regularly while using RYALTRIS.

Call your healthcare provider or get medical help right away if you have symptoms of any of the serious side effects listed above.

  • The most common side effects of RYALTRIS include unpleasant taste, nosebleeds and nasal discomfort.
  • Tell your healthcare provider if you have side effects that bother you or do not go away.
  • These are not all of the possible side effects of RYALTRIS. For more information, ask your healthcare provider or pharmacist.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. RYALTRIS and other medicines may affect each other, causing side effects.

Especially tell your healthcare provider if you take:

  • Certain medicines for HIV, cobicistat-containing products, certain antifungals, certain antibiotics and/or certain antidepressants. Ask your healthcare provider or pharmacist for a list of your medicines if you are not sure.

Before you use RYALTRIS, tell your healthcare provider about all of your medical conditions, including if you:

  • Have had recent nasal sores, nasal surgery or nasal injury.
  • Have eye or vision problems, such as cataracts or glaucoma (increased pressure in your eyes).
  • Have tuberculosis or any untreated fungal, bacterial or viral infections or eye infections caused by herpes.
  • Have been near someone who has chickenpox or measles.
  • Are not feeling well or have any other symptoms that you do not understand.
  • Are pregnant or plan to become pregnant. It is not known if RYALTRIS will harm your unborn baby. Talk to your healthcare provider if you are pregnant or plan to become pregnant.
  • Are breastfeeding or plan to breastfeed. It is not known if RYALTRIS passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby while using RYALTRIS.

INDICATIONS

RYALTRIS is a prescription nasal spray that contains 2 medicines, olopatadine hydrochloride, an antihistamine, and mometasone furoate, a corticosteroid. RYALTRIS is indicated for the treatment of symptoms of seasonal allergic rhinitis in adult and pediatric patients 12 years of age and older.

For more information, please see Full Prescribing Information.

To report an adverse event or product complaint, please contact us at us.hikma@primevigilance.com or call 1-877-845-0689 or 1-800-962-8364.

Adverse events may also be reported to the FDA directly at 1-800-FDA-1088 or https://www.fda.gov/medwatch.

RYALTRIS and the RYALTRIS logo are registered trademarks of Glenmark Specialty SA.

Distributed by: Hikma Specialty USA Inc. Columbus, OH 43228

Reference

  1. RYALTRIS® Nasal Spray approved prescribing information, Glenmark Specialty SA, Switzerland.