For eligible, commercially insured patients, Merz will reimburse out-of-pocket XEOMIN medication costs and related administration fees not covered by insurance, up to $5,000 EVERY 12 MONTHS.* Eligible commercially insured patients may pay as little as $0 out of pocket with the XEOMIN Patient Savings Program.*†
To be eligible, you must:
Be a clinically appropriate patient for therapeutic treatment with XEOMIN, as determined by your doctor
Be prescribed XEOMIN
Be at least 18 years of age and less than 65 years of age
Have commercial insurance that covers XEOMIN medication costs
Not be enrolled in a state-funded or federally funded prescription insurance program*
For residents of Massachusetts, Michigan, Minnesota, and Rhode Island, further restrictions apply*
Submit claims within 120 days of date of service
The following costs are not eligible and will not be reimbursed:
Office visit co-pays not directly associated with XEOMIN treatment
Facility co-pays not directly associated with XEOMIN treatment
Any other costs excluded by the MERZ CONNECT guidelines not specifically mentioned above, which are subject to change
In accordance with state law, MERZ CONNECT does not reimburse injection-related charges for patients residing in Massachusetts, Michigan, Minnesota, and Rhode Island
*Restrictions apply to eligibility. Commercial Insurance required. Reimbursement limited to out-of-pocket XEOMIN medication costs and related administration fees. State limitations may apply. Please see Full Terms and Conditions at XEOMIN.com. Merz reserves the right to change XEOMIN Patient Savings Program Terms and Conditions, including the eligibility requirements, at any time. This is not health insurance.
†You may be required to pay upfront for your co-pay/co-insurance, as determined by your insurance coverage/policy and your healthcare provider’s co-pay collection practice.
Further restrictions apply to eligibility and reimbursable expenses. Please seebelow or call 1-888-4-XEOMIN (1-888-493-6646).
The Program covers eligible patients’ actual out-of-pocket XEOMIN medication costs and related administration fees up to a maximum amount of $5,000 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 8am-8pm ET 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.
To obtain a XEOMIN Patient Savings Program application, you can:Download an application
For additional information, please download the XEOMIN Patient Savings Program brochure,available here:
Read the Medication Guide before you start receiving XEOMIN® (Zeo-min) and each time XEOMIN is given to you as there may be new information. The risk information provided here is not comprehensive. To learn more:
XEOMIN is a prescription medicine used in adults:
It is not known if XEOMIN is safe and effective in children under 18 years of age.
XEOMIN may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems anytime (hours to weeks) after treatment with XEOMIN:
These symptoms can happen hours to weeks after you receive an injection of XEOMIN. These problems could make it unsafe for you to drive a car or do other dangerous activities.
Do not take XEOMIN if you: are allergic to XEOMIN or any of the ingredients in XEOMIN (see the end of this Guide for a list of ingredients in XEOMIN), had an allergic reaction to any other botulinum toxin product such as rimabotulinumtoxinB (Myobloc®), onabotulinumtoxinA (Botox®, Botox® Cosmetic), or abobotulinumtoxinA (Dysport®) or have a skin infection at the planned injection site.
Tell your doctor about all of the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Talk to your doctor before you take any new medicines after you receive XEOMIN.
Using XEOMIN with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received XEOMIN in the past. Especially tell your doctor if you:
Ask your doctor if you are not sure if your medicine is one that is listed above.
Know the medicines you take. Keep a list of your medicines with you to show your doctor and pharmacist each time you get a new medicine.
XEOMIN can cause serious side effects including:
The most common side effects of XEOMIN in people with chronic sialorrhea include:
The most common side effects of XEOMIN in people with upper limb spasticity include:
The most common side effects of XEOMIN in people with cervical dystonia include:
The most common side effects of XEOMIN in people with blepharospasm include:
These are not all the possible side effects of XEOMIN.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. You can ask your pharmacist or doctor for information about XEOMIN that is written for health professionals.
Active Ingredients: botulinum toxin type A
Inactive Ingredients: human albumin and sucrose