Xeomin Patient Assistance Program

Funded

About

The Xeomin Patient Assistance Program offers eligible patients access to the drug Xeomin at no cost, especially those who are uninsured or underinsured. By providing comprehensive support through its structured eligibility and renewal process, the Xeomin Patient Assistance Program ensures that patients meet necessary financial and medical criteria, thereby facilitating essential treatment for those in need.

Insurance requirements: 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

•Eligible uninsured or underinsured patients may be able to receive XEOMIN at no cost

•Completed enrollment form must be faxed to 8558250488

•For assistance, call 8554637989 option 4, to reach a MERZ CONNECT specialist Monday through Friday between 8am7pm ET

Enrollment Forms

Enrollment Form