Co-Pay Assistance Program for Myobloc

Funded
About
The Co-Pay Assistance Program for Myobloc offers significant financial savings for eligible patients using Myobloc for conditions such as cervical dystonia or chronic sialorrhea. The program makes sure that insured patients can access Myobloc with minimal out-of-pocket expenses, sometimes paying no more than $0, with a potential annual savings of up to $4,000. By leveraging the Co-Pay Assistance Program for Myobloc, patients can ensure that they receive necessary treatments without the burden of excessive costs, reinforcing the importance of Myobloc as a critical therapeutic option.
Insurance requirements: Commercially insured
Enrollment Forms
Enrollment Form
Benefits
•$4000 annual maximum benefit
•12 maximum fills per year
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
•Eligible insured patients may pay no more than $0 for MYOBLOC and the administrative services associated with MYOBLOC, up to a maximum savings limit of $4,000 per year
•Patient's healthcare provider can enroll OR patients can call 18884612255, Option 3 to enroll; no enrollment forms needed & no financial requirements (HCP can fax completed enrollment form)
•Patient will receive a letter in the mail with the Enrollment Application to continue in the program for one year
•Conditional approval may be granted for a sixty (60) day period for applications submitted via online enrollment or enrollment by telephone
•Upon conditional approval, a patient can schedule an appointment to receive the first injection of MYOBLOC
•Patient’s eligible outofpocket expenses may be paid directly to the site of care (administering office or pharmacy) on the patient’s behalf, or to the patient as a reimbursement for outofpocket expenses paid to the site of care
•Site of care must first file a claim for MYOBLOC and the related injectionadministration expenses with the patient’s private insurance carrier
•Patient outofpocket expense may vary
•For more information, call 18884612255, Option 3, MF 8 AM8 PM ET