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COSOPT®/ COSOPT® Preservative-Free

If you are seeking to receive a COSOPT®
/ COSOPT® Preservative Free Patient Assist RxHelp Card and you have a valid prescription for COSOPT® or COSOPT® Preservative Free you may enrol in the program.



The COSOPT ®/COSOPT ® Preservative-Free Patient Assist RxHelp™ program allows patients to obtain financial assistance up to a maximum of 25% of the drug ingredient cost for their initial new prescription of COSOPT ® Preservative-Free Formulation (dorzolamide hydrochloride and timolol maleate) OR financial assistance up to a maximum of 50% of the drug ingredient cost for their new or repeat COSOPT ® (dorzolamide hydrochloride and timolol maleate) prescriptions.

 

You have the option of registering online or by phone:

  • online by clicking on the button below to register or
  • by phone by calling 1-866-RxHelp4 (794-3574)
By registering for this program I confirm that I have read, understood and consented to the RxHelp.ca Privacy Policy and Terms and Conditions.
I confirm that I have a current prescription for COSOPT® or COSOPT® Preservative Free.
I am a physician or pharmacist and I would like to order cards for distribution to my patients.
Check if you would like to receive up to date information on RxHelp program offerings. You may withdraw your consent at any time.
I already have a card. Please send me information on updates on future similar programs or changes to the current program. I may withdraw my consent at any time.
OR

Address Verification

To ensure delivery, please confirm your address, including Apt/Suite/Unit # if required before submitting the form :