Xeomin Patient Savings Program

Funded

About

The Xeomin Patient Savings Program offers substantial financial assistance for patients prescribed Xeomin, aiming to make this therapeutic treatment more accessible. Eligible patients, who must be between the ages of 2 and 65 and have commercial insurance, can benefit from a significantly reduced copay, potentially as low as $0, for their Xeomin medication costs. The program also allows for reimbursement of administration fees up to a maximum of $5,000 annually. The Xeomin Patient Savings Program emphasizes facilitating patient access via the Merz Connect Portal, offering vital support and assistance to ensure affordability and ease of treatments.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•$5000 annual maximum benefit

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

•SPECIALTY PHARMACY SPs can help patients apply for the XEOMIN Patient Savings Program via the Merz Connect Portal: https://merzconnectpatientportal.com/

•Eligible patients can pay as little as a $0 copay for their outofpocket XEOMIN medication costs and, where permissible, related administration fees, up to a maximum amount of $5,000 annually

•Actual copay and outofpocket expense may vary depending upon the patient's specific commercial insurance plan and state requirements

•Office copays not directly associated with XEOMIN treatment and facility copays not directly associated with XEOMIN treatment are not covered

•Patients residing in Massachusetts and Rhode Island are eligible for drug copayment assistance only and are not eligible for other types of copayment assistance, including but not limited to costs related to administration of the drug

•Patients have the option to receive their reimbursement check directly (default), or assign their benefits to their provider for payment of their eligible XEOMINrelated expenses

•Proof required for receiving payment for outofpocket drug costs must be a valid explanation of benefits (EOB) or specialty pharmacy invoice, which must be submitted within 180 days after each treatment.

•Enrollment in the Program may be reviewed on an annual basis to determine continued eligibility

•Offer may not be combined with any other coupon, discount, prescription savings card, free trial, or other offer for XEOMIN

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

Enrollment Forms

Enrollment Form