XEOMIN® Access and Support

We have resources and support programs for patients and caregivers. From reimbursement support to advocacy groups, we're here to help.

For Your Practice For Your Patients

Financial assistance programs

Support for your patients

The XEOMIN Patient Savings Program

See how we can help support appropriate patient access to XEOMIN therapy.

Download an electronic brochure here.

Merz North America, Inc. reserves the right to modify or discontinue any and all aspects of the program at any time and without notice.

Further restrictions apply to eligibility and reimbursable expenses. Please see full terms and conditions below or call 1-888-4MY-MERZ (1-888-469-6379), Option 2.

How it works

Benefits demonstration: Mary Smith, Age 56*

Please see full terms and conditions. Please see the XEOMIN Patient Savings Program Information page for complete details and to download an application. Patients who move from commercial insurance coverage to federally- or state-funded programs will no longer be eligible for the Program.

Patients must sign and date a XEOMIN® Patient Savings Program Application and must re-enroll every 12 months.

Merz North America, Inc. reserves the right to modify or discontinue any and all aspects of the program at any time and without notice.

* Illustration of savings program benefits. Not a real patient.

† Example calculation for illustrative purposes. Patient benefits will vary depending on their specific commercial insurance plan.

Eligibility, Terms and Conditions, and Program Limitations

The Program covers eligible patients’ actual out-of-pocket XEOMIN medication costs and related administration fees up to a maximum amount of $3500 per 12-month period beginning with patient’s acceptance into Program (no earlier than July 1, 2016). The Program does not cover (a) office visit co-pays not directly associated with XEOMIN treatment; (b) facility co-pays not directly associated with XEOMIN treatment; or (c) any other costs excluded by the Program guidelines not specifically mentioned herein, which are subject to change.

Eligible patients must be clinically appropriate patients for therapeutic treatment with XEOMIN. Patient must be prescribed XEOMIN. Eligible patients must be at least 18 years of age and less than 65 years of age.

This offer is valid only in the United States, excluding where it is otherwise prohibited by law. Patients residing in the states of Massachusetts, Michigan, Rhode Island, and Minnesota are eligible for drug co-payment assistance only and are not eligible for other types of co-payment assistance, including but not limited to costs related to administration of the drug.

Eligible patients must have private commercial insurance that covers medication costs for XEOMIN, and acceptance of this offer must be consistent with the terms of that insurer’s drug benefit. Eligible patients must not have coverage for XEOMIN through Medicare, Medicare Advantage, Medicare Part D, Medicaid, Medigap, TRICARE, Veterans Affairs (VA), the Department of Defense (DoD), or other federally-funded or state-funded healthcare programs. Patients who move from commercial to federally-funded or state-funded insurance will no longer be eligible for the Program. Proof required for receiving payment for out-of-pocket drug costs must be a valid explanation of benefits (EOB) or specialty pharmacy invoice, which must be submitted within 120 days after each treatment.

Patient may not seek reimbursement for value received from the Program from any third-party payers, including flexible spending accounts or healthcare savings accounts. If at any time patient begins receiving coverage under any federal, state or government-funded healthcare program, Patient is no longer eligible to participate in the Program and must call 1-888-4MY-MERZ (1-888-469-6379) between 8 AM and 8 PM (EST) to stop participation. Restrictions may apply. This is not health insurance.

Patient and patient’s pharmacist are responsible for notifying insurance carriers or any other third party who pays for or reimburses any part of the prescription filled using the Program as may be required by the insurance carrier’s terms and conditions and applicable law.

Enrollment in the Program may be reviewed on an annual basis to determine continued eligibility. This offer may not be combined with any other coupon, discount, prescription savings card, free trial, or other offer for XEOMIN.

This is a limited time offer, and Merz reserves the right to rescind, revoke, amend, or terminate this offer, or the program in its entirety, at any time, without notice.

Financial Assistance Programs

XEOMIN Patient Assistance Program*

Merz is proud to offer a Patient Assistance Program (PAP) that provides XEOMIN at no charge to eligible patients. XEOMIN is available at no charge to patients who:

For underinsured patients, the physician must follow the steps below before drug at no charge will be provided unless otherwise instructed by the XEOMIN reimbursement support staff:

* Merz North America, Inc. reserves the right to modify or discontinue any and all aspects of the program at any time and without notice.

† Criteria for the Patient Assistance Program (PAP) are established by Merz North America, Inc. Acceptance into the program does not entitle patients to receive assistance indefinitely. Eligibility must be re-established every twelve (12) months and assistance under the program may be terminated at any time. Changes in the status of the patient’s eligibility (such as changes in income and health coverage) should be reported to the Merz Neurosciences Patient Assistance Program within 30 days. Please see the Patient Assistance Program application for additional details.

Downloadable Forms

Patient Assistance Program Enrollment Form

This application should be completed by patients to determine if they are eligible for our Patient Assistance Program for uninsured or underinsured patients.

Click to Download
Patient Savings Program Application

This application should be completed by patients to determine if they are eligible for our Patient Savings Program.

Click to Download
XEOMIN Patient Savings Program Patient Brochure

This electronic brochure provides your patients additional information about the XEOMIN Patient Savings Program.

Click to Download

Call toll-free 1-844-4MyMerz (1-844-469-6379) to reach a Next Steps specialist

Click Here to Register for or Log in to the XEOMIN eSupport site

Advocacy Groups

American Dystonia Society Benign Essential Blepharospasm Research Foundation Dystonia Medical Research Foundation National Institute of Neurological Disorders and Stroke National Spasmodic Torticollis Association National Stroke Association ST Dystonia, Inc.

Reference

  1. 2015 CPT Professional Edition. American Medical Association; 2014. Current Procedural Terminology (CPT®) copyright 2014 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.