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iLink® Patient Savings Program Terms & Conditions

Program Terms, Conditions, and Eligibility Criteria:

  1. Offer valid only for commercially insured patients who are prescribed Photrexa® drug formulations for on-label use with the iLink cross-linking procedure and whose insurance plan covers the iLink cross-linking procedure.
  2. Offer not valid for use by patients receiving reimbursement under any federal, state,
    or government-funded healthcare programs (e.g., Medicare, Medicare Advantage,
    Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs);
    private indemnity or HMO insurance plans that reimburse patients for the entire cost of
    their prescription drugs; or where prohibited by the patient’s health insurance provider.
    This offer is not valid for cash-paying patients. This offer is also not valid for commercially
    insured patients whose insurance plans do not cover the iLink cross-linking procedure or
    whose claim was denied as being off-label or not medically necessary.
  3. Subject to insurance coverage, eligible commercially insured patients may get up to $600
    per eye towards non-reimbursable copay expenses for the Photrexa® drug formulations
    [Photrexa® Viscous (riboflavin 5’-phosphate in 20 % dextran ophthalmic solution), Photrexa®
    (riboflavin 5’-phosphate ophthalmic solution)] used in the iLink cross-linking procedure. This
    offer applies to the out-of-pocket costs for the pharmaceutical fee only and does not apply
    to costs for any other medication, procedure, or diagnostic service. Patient out-of-pocket
    expenses will vary.
  4. Offer applies to to procedures completed during the current program offering period
    ending September 30, 2026. Savings requests must be submitted within 180 days of the
    treatment date (no later than March 31, 2027) and include a copy of an Explanation of
    Benefits (EOB) identifying J2787 for the Photrexa drug formulations and confirmation from
    the healthcare provider of the on-label diagnosis.
  5. Glaukos reserves the right to rescind, revoke, or amend this offer without notice.
  6. Offer good only in the USA, including Puerto Rico and Guam. Patients residing in or receiving
    treatment in certain states may not be eligible to participate in this program.
  7. Void if prohibited by law, taxed, or restricted.
  8. Offer is nontransferable. The selling, purchasing, trading, or counterfeiting of this offer is
    prohibited by law.
  9. Offer has no cash value and may not be used in combination with any other discount,
    coupon, rebate, free trial, or similar offer for the specified prescription.
  10. This offer is not health insurance.
  11. Program expires September 30, 2026.
  12. By redeeming this offer, patient must meet the eligibility criteria above and patient
    understands and agrees to comply with the terms and conditions of this offer. Receipt of
    the benefit is dependent on patient completion and approval by Glaukos of the program
    application. For questions about the program, please call 1-833-855-3031 or email GPS@
    glaukos.com.
  13. Photrexa Viscous® and Photrexa for use with the KXL® System was discontinued from the
    market effective January 31, 2026. Limited supply of Photrexa remains available within the
    distribution network.

Glaukos reserves the right at any time to delete, modify, or change the terms and conditions without notice.

Important Safety Information

Ulcerative keratitis, a potentially serious eye infection, can occur. Your doctor should monitor defects in the outermost corneal layer of the eye for resolution.

The most common ocular side effect is haze. Other ocular side effects include inflammation, fine white lines, dry eye, disruption of surface cells, eye pain, light sensitivity, reduced sharpness of vision, and blurred vision. The risk information provided here is not comprehensive. To learn more, talk to your healthcare provider.

Go to Prescribing Info to obtain the FDA-approved product labeling.

You are encouraged to report all side effects to the FDA. Visit www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program, or call 1-800-FDA-1088.

Approved Uses

Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate ophthalmic solution) are used with the KXL® System in corneal cross-linking to treat eyes in which the cornea, the clear dome shaped surface that covers the front of the eye, has been weakened from the progression of the disease keratoconus or following refractive surgery, a method for correcting or improving your vision.

Tell your healthcare provider if you are pregnant or plan to become pregnant.