OmidriAssure "We Pay the Difference" Commercial Reimbursement Program - Covered benefit

Coverage RequiredFunded

About

The OmidriAssure "We Pay the Difference" Commercial Reimbursement Program facilitates access to the drug product Omidria for patients with commercial insurance. This beneficial program ensures that qualified patients can receive Omidria at a covered benefit by managing reimbursement claims efficiently. OmidriAssure emphasizes the importance of submitting claims promptly and includes essential documents such as the EOB and CMS claim form.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: Yes

•Needs Based: No

•Activation Required: No

Program Details

•Claims must be submitted within 180 days from the date of service, covered benefit required, EOB and CMS claim form (1500/UB04) need to be included

Enrollment Forms

Enrollment Form