For Indication and Important Safety Information about each product included in Aqua Advantage,
please click on the product image above.

GET
your savings card

Activation Step 1 of 3

You did not answer one or more of the questions. Please review your responses and make corrections where necessary.

Please indicate the Aqua products for which you will be using your SuccessFillâ„¢ card. Check all that apply:



You must select a product to move on.

Are you a current Resident in one of the fifty United States or Puerto Rico?

You are not eligible to participate in this program because you are not a resident of the United States or Puerto Rico. Thank you for your interest.

Do you have insurance coverage that covers prescription drugs?

You must have insurance coverage to participate in the Access Savings Program.

Are your prescriptions paid for in part or full under any state or federally funded programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TriCare?

You are not eligible to participate in this program because you currently participate in a government, state or federally funded prescription drug program. Thank you for your interest.

Your card is not valid for prescriptions purchased under Medicaid, Medicare or similar federal, state or other government funded benefit programs. Should you begin receiving prescription benefits from such a federal, state or government funded program at any time, you will no longer be eligible to participate in the Loyalty program. We may contact you by phone or mail periodically in order to verify that your eligibility for the program has not changed. Do you acknowledge your agreement with this statement?

You are not eligible to participate in this program. Thank you for your interest. If you would like to discuss this further, please call 1-855-264-9637.

I understand that certain information pertaining to my use of the card will be shared by my pharmacy with Aqua Pharmaceuticals, the sponsor of the card. The information disclosed will include the date that I filled the prescription, the number of pills dispensed by my pharmacist, and the amount that I will be reimbursed by Aqua Pharmaceuticals under the SuccessFillâ„¢ program. This information will be available to Aqua Pharmaceuticals and third parties working on behalf of Aqua Pharmaceuticals, and will not be shared with anyone else. You may opt-out at any time by calling 1-888-591-9860 .

This field is required. Please select your option.

This program is not health insurance.
This program is available only at participating pharmacies.
Aqua Pharmaceuticals retains the right to rescind, revoke, or change the benefit at any time.

By using the Aqua Advantage card, I agree to the terms and conditions of this program.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.