OmidriAssure "Equal Access" Patient Assistance Program
Funded
About
The OmidriAssure 'Equal Access' Patient Assistance Program offers substantial benefits by providing Omidria at no cost for eligible surgeries. This program, OmidriAssure, is designed to ensure that eligible U.S. patients have access to Omidria during surgery without the financial burden, making healthcare more accessible and equitable.
Insurance requirements: Medicare / Medicaid, Underinsured, Uninsured
Enrollment Forms
Enrollment Form
Program Requirements
•Valid only for residents in the US and Puerto Rico
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: Yes
•Activation Required: No
Program Details
•Patient must complete relevant fields in the Patient Certification Form; Facility must sign the Physician Certification
•Completed forms must be faxed to: 8556167741
•If patient meets the eligibility criteria for the Equal Access PAP, OMIDRIA will be provided at no cost for use during patient’s surgery
•Call 8776643742, Monday through Friday, 9AM 5PM Eastern Time, for more information
Enrollment Forms
Enrollment Form
Other Programs
OmidriAssure "We Pay the Difference" Commercial Reimbursement Program - Covered benefit
Omidria at no costSee program details for eligibility
OmidriAssure "We Pay the Difference" Commercial Reimbursement Program - Non-covered benefit
Omidria at no costSee program details for eligibility