Dosage & Administration Drug label Prior authorization Financial assistance

Dysport

(botulinum toxin type A)

abobotulinumtoxinA 300 UNT Injection [Dysport]

Dosage & administration

Preparation of DYSPORT Solution for Administration

* Once reconstituted, store in original container in a refrigerator 2°C to 8°C (36°F to 46°F) and use within 24 hours
* Do not freeze after reconstitution
* Reconstitution instructions are specific for the 300 Unit and 500 Unit vials
* Reconstituted DYSPORT is intended for intramuscular injection only. After reconstitution, DYSPORT should be used for only one injection session and for only one patient.

Cervical Dystonia

• Initial dose is 500 Units given intramuscularly as a divided dose among the affected muscles
• Re-treatment every 12 to 16 weeks or longer, as necessary, based on return of clinical symptoms with doses administered between 250 and 1000 Units to optimize clinical benefit
• Re-treatment should not occur in intervals of less than 12 weeks
• Titrate in 250 Unit steps according to patient's response

Glabellar Lines

* Administer a total dose of 50 Units, divided in five equal aliquots of 10 Units each, intramuscularly to affected muscles to achieve clinical effect
* Re-treatment should be administered no more frequently than every 3 months

Spasticity in Adults

* Select dose based on muscles affected, severity of spasticity, and treatment and adverse reaction history botulinum toxins
* Dosing for upper limb spasticity: between 500 Units and 1000 Units
* Dosing for lower limb spasticity: up to 1500 Units
* The maximum recommended total dose per treatment session (upper and lower limb combined) in adults is 1500 Units
* Re-treatment, based on return of clinical symptoms, should not occur in intervals of less than 12 weeks

Spasticity in Pediatric Patients

* Select dose based on the affected muscle, severity of spasticity, and treatment and adverse reaction history with all botulinum toxins.
* Recommended dosing for upper limb spasticity: 8 Units/kg to 16 Units/kg per limb. The maximum recommended total dose administered per treatment session must not exceed 16 Units/kg or 640 Units, whichever is lower.
* Recommended dosing for lower limb spasticity: 10 Units/kg to 15 Units/kg per limb. Total dose per treatment session must not exceed 15 Units/kg for unilateral lower limb injections, 30 Units/kg for bilateral injections, or 1000 Units, whichever is lower.
* The maximum recommended total dose per treatment session is 30 Units/kg or 1000 Units, whichever is lower. Re-treatment, based on return of clinical symptoms, should not occur in intervals of less than 3 months.

drug label

Dysport prescribing information

Need to report a Dysport issue?

ONLINE FORMReport adverse event

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prior authorization

Dysport Prior authorization resources

Complete Letter of Medical Necessity

Coverage Authorization Request

Coverage Authorization Appeals

Med D Tier Exception

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Benefits investigation

Ipsen Cares Enrollment Form

Ipsen Cares Enrollment Form - Online

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Reimbursement help (FRM)

NOT PROVIDED BY BRANDReimbursement help (FRM) resources

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financial assistance

Dysport Financial assistance options

Co-pay savings program

commercial only

Ipsen Cares Enrollment Form

Ipsen Cares Enrollment Form - Online

Enroll in Patient Savings Program

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Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Bridge program

commercial only

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Overview

Provide patient immediate access to therapy during an insurance delay (typically new starts; some may cover change in insurance)
Limited time/ fill (typically 7-30 days; some may offer additional fill for continued delay up to certain limit)

Patient benefit

100% free (outside of insurance)

Patient eligibility

HCP must enroll patient
May be limited to commercially insured patients (i.e., no government beneficiaries); some programs may allow government beneficiaries

How to sign up

Typically HCP assisted enrollment (via form)

Foundation programs

under insured

no insurance

goverment insurance

65+

Ipsen Care Patient Assistance Program

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Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and co-pays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.

How to sign up

Patients submit proof of out-of-pocket drug costs to charities for reimbursement

patient education

Dysport Patient education

Getting started on Dysport

NOT PROVIDED BY BRANDInstructions For Use: Cervical Dystonia

NOT PROVIDED BY BRANDInstructions For Use: Adult Spasticity

NOT PROVIDED BY BRANDInstructions For Use: Pediatric Spasticity