Durysta CoPay Assistance Program

Funded

About

The Durysta CoPay Assistance Program offers significant financial relief for patients prescribed Durysta, allowing eligible participants to potentially receive up to one implant per eye at little to no cost. This program is designed to assist those with private insurance by covering a substantial portion of their copay. The Durysta CoPay Assistance Program extends its benefits to eligible patients across the USA, including Puerto Rico, providing easy enrollment via Allergan EyeCue.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•$4200 annual maximum benefit

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•**PLEASE Expiration date has not been updated by Allergan, but program is still valid**

•Commercially eligible patients may pay as little as $0 for each of up to one implant per eye

•This offer applies to the implant only and does not apply to costs for any other medication, procedure, or diagnostic service

•Depending on patient's insurance coverage, maximum benefit and patient out of pocket expense may vary

•HCP's can enroll their patient through Allergan EyeCue at https://www.allerganeyecue.com/#/login

•Completed enrollment form should be uploaded to the Allergan EyeCue portal or faxed to 18666764069

•For more information or questions patients must call 18333879782, option 2 (MondayFriday, 9am8pm ET) or email durystasupport@iqvia.com

Enrollment Forms

Enrollment Form