SIGN UP FOR SAVINGS, IF ELIGIBLE*

* With this Savings Card, you may pay as little as $4 for each 28-day fill of TOBI® (tobramycin inhalation solution, USP), while this program remains in effect. This Savings Card may be used to reduce the amount of your out-of-pocket costs for TOBI up to the full amount of your out-of-pocket cost per 28-day prescription, after you pay the first $4 per 28-day prescription, up to an aggregate maximum of $14,000 per calendar year while this program remains in effect. No other purchase is necessary. Valid prescription with Prescriber ID# is required. Viatris Specialty LLC reserves the right to amend or end this program at any time without notice.
Eligibility Requirements: This Savings Card can be redeemed only by patients or patient guardians who are 18 years of age or older and who are residents of the United States and its territories. Patients must have commercial insurance. This program is not valid for uninsured patients (but may be used by commercially insured patients without coverage for TOBI) and patients who are covered by any state or federally funded healthcare program, including but not limited to any state pharmaceutical assistance program, Medicare (Part D or otherwise), Medicaid, Medigap, VA or DOD, or TRICARE (regardless of whether TOBI is covered by such government program); not valid if the patient is Medicare-eligible and enrolled in an employer-sponsored health plan or prescription benefit program for retirees; and not valid if the patient's insurance plan is paying the entire cost of this prescription. This program is void outside the US and its territories or where prohibited by law, taxed, or restricted. Absent a change in Massachusetts law, this program will no longer be valid for Massachusetts residents as of January 1, 2026. This program is not valid for residents of California. Read more for full terms and conditions.


If you are a healthcare provider, by providing your patient's information to sign up your patient for the TOBI Savings Card program, you are certifying that you have received from your patient all permissions required under law (including authorizations under HIPAA and state law) to disclose this information to Viatris Specialty LLC, and you have notified the patient of the Savings Card full terms and conditions.


Please provide the information below

 

Does the patient already have the TOBI Savings Card?

Yes
No

Do you have a license to provide healthcare or medical services in the states of Vermont or Massachusetts?

Yes
No

You certify that you are the patient or the patient's caregiver and have the legal authority to act on behalf of the patient and proceed with the enrollment of the TOBI Savings Card, and you have notified the patient of the Savings Card full terms and conditions.


PATIENT'S FIRST NAME

PATIENT'S LAST NAME

PATIENT'S ADDRESS

PATIENT'S CITY

PATIENT'S STATE

PATIENT'S ZIP

PATIENT'S BIRTH DATE

PATIENT'S PHONE

PATIENT'S MOBILE PHONE (Optional)


What type of prescription coverage does the patient have?

What type of prescription coverage does the patient have?

Commercial (also known as private) insurance.
State or federally funded insurance (including, but not limited to, Medicare, Medicaid, VA, DoD, or TRICARE)
No insurance

The enrollee is:

A patient over 18 years of age
A caregiver or patient guardian over 18 years of age



Sign Up for Updates:

YOUR EMAIL


By signing up, you authorize Viatris Inc. and trusted parties acting on its behalf, to send you the TOBI materials you requested and other commercial communications from Viatris Inc. By enrolling, you confirm that you are a resident of the United States and over 18 years of age.

Viatris Inc. understands that your personal and health information are private. To learn about how Viatris Inc. uses your information, please view our Privacy Notice.

We do not sell your email address and you may opt out at any time. Deciding not to receive email communications will in no way affect eligibility for the Savings Card program.

Close




SUBMIT
loader.gif