For adults with diabetic macular edema, macular edema following branch or central retinal vein occlusion, or noninfectious posterior segment uveitis

Welcome to the OZURDEX® Savings Program


Our savings program can help eligible patients
pay as little as $50 for OZURDEX®.
If you are a patient interested in enrolling, please
contact your healthcare provider’s office who
can assist with the enrollment process.
Who is eligible?

Patients must meet the following criteria to be eligible:

  • Be a resident of the United States, Puerto Rico, or Guam and at least 18 years of age
  • Be prescribed OZURDEX® for an approved use
  • Receive treatment after January 2020
  • Have commercial or private health insurance
  • Have insurance coverage for OZURDEX® for an approved use
  • Have no government-sponsored insurance coverage such as Medicare or Medicaid

Patients are not eligible if they have government insurance (ie, patients are enrolled in any state or federally funded programs, including, but not limited to, Medicare, Medicaid, Medigap, Veterans Affairs [VA], Department of Defense [DoD], CHAMPVA, or TRICARE). Void where prohibited by law, taxed, or restricted.

When should patients enroll?

Patients should enroll before receiving their first injection.

How does the program work?
To enroll a patient:
1
Go to Allergan EyeCueSM portal and login or, if you do not already have an Allergan EyeCue account, create a username and password
2
Complete the OZURDEX® Patient Enrollment Form and obtain required patient and physician signatures on HIPAA authorization for the use and disclosure of patient information and patient certification for Allergan programs
3
Upload all 3 pages to Allergan EyeCueSM portal
4
Allergan EyeCueSM will email you to confirm or deny patient eligibility into the OZURDEX® Savings Program. The results can also be found on the Benefits Verification summary. If approved, you also will receive the patient member ID and it will be saved under the patient case information in the Allergan EyeCueSMportal.
For reimbursement:
1
Prior to OZURDEX® injection, determine the patient’s out-of-pocket cost and collect savings program copay (minimum of $50 per eye)
3
Complete and sign the OZURDEX® Savings Physician Reimbursement Request Form, which includes the $50 copay attestation
4
Submit the signed Savings Program Physician Reimbursement Form and supporting documents HCFA 1500 form, Explanation of Benefits [EOB] document[s] to the Allergan EyeCueSM portal
5
Allergan EyeCueSM portal will send you an email to confirm whether the submission is approved
6
If approved, you will receive a reimbursement check in
4 to 6 weeks
Program Enrollment Enroll your patients through Allergan EyeCueSM by clicking below. If you have current patients in the OZURDEX® Savings Program with a Member ID Starting With “OZ”, you will need to enroll them via Allergan EyeCueSM by July 1, 2020 for seamless savings program coverage.
Physician Reimbursement Request For savings program patients with member IDs starting with "OZ," click the button below or contact 1-855-454-6369 or you may fax the reimbursement claim to 1-347-630-0347.
(NOTE: After July 1, 2020, all reimbursement claims must be processed through Allergan EyeCueSM and member IDs must start with “J”)
For OZURDEX® Savings Program patients enrolled after February 2020 with member IDs starting with “J,” click below to submit the reimbursement claim through Allergan EyeCueSM.
Please Select One:
Check Your Eligibility
I am at least 18 years of age.
I currently live in the United States, Puerto Rico, or Guam.
I have private/commercial health insurance. (eg, through my employer or an
exchange, NOT a federal or state health program such as Medicare, Medicaid, TRICARE, or similar program.)
My current income meets the following requirements*:
  • For a household size of 1, less than or equal to $60,000
  • For a household size of 2-4, less than or equal to $125,000
  • For a household size of 5 or more, less than or equal to $150,000
I received or will receive treatment with OZURDEX® (dexamethasone intravitreal
implant) during or after December 2017.
* Household = tax filer + spouse + number of tax dependents. Follow these basic rules when including members of your household: (1) include your spouse if you’re legally married; (2) if you plan to claim someone as a tax dependent, do include them on your application; (3) if you won’t claim someone as a tax dependent, don’t include them.
Approved Uses

OZURDEX® (dexamethasone intravitreal implant) is a prescription medicine that is an implant injected into the eye (vitreous) and used:

  • To treat adults with diabetic macular edema
  • To treat adults with swelling of the macula (macular edema) following branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO)
  • To treat adults with noninfectious inflammation of the uvea (uveitis) affecting the back segment of the eye
IMPORTANT SAFETY INFORMATION
When Not to Use OZURDEX®

OZURDEX® should not be used if you have any infections in or around the eyes, including most viral diseases of the cornea and conjunctiva, including active herpes viral infection of the eye, vaccinia, varicella, mycobacterial infections, and fungal diseases.

OZURDEX® should not be used if you have glaucoma that has progressed to a cup-to-disc ratio of greater than 0.8.

OZURDEX® should not be used if you have a posterior lens capsule that is torn or ruptured.

OZURDEX® should not be used if you are allergic to any of its ingredients.

Warnings and Precautions

Injections into the vitreous in the eye, including those with OZURDEX®, are associated with serious eye infection (endophthalmitis), eye inflammation, increased eye pressure, and retinal detachments. Your eye doctor should monitor you regularly after the injection.

Use of corticosteroids including OZURDEX® may produce posterior subcapsular cataracts, increased eye pressure, glaucoma, and may increase the establishment of secondary eye infections due to bacteria, fungi, or viruses. Let your doctor know if you have a history of ocular herpes simplex as corticosteroids are not recommended in these patients.

Common Side Effects in Diabetic Macular Edema

The most common side effects reported in patients with diabetic macular edema include: cataract, increased eye pressure, conjunctival blood spot, reduced vision, inflammation of the conjunctiva, specks that float in the field of vision, swelling of the conjunctiva, dry eye, vitreous detachment, vitreous opacities, retinal aneurysm, foreign body sensation, corneal erosion, inflammation of the cornea, anterior chamber inflammation, retinal tear, drooping eyelid, high blood pressure, and bronchitis.

Common Side Effects in Retinal Vein Occlusion and Noninfectious Posterior Segment Uveitis

The most common side effects reported in patients for retinal vein occlusion and uveitis include: increased eye pressure, conjunctival blood spot, eye pain, eye redness, ocular hypertension, cataract, vitreous detachment, and headache.

Patient Counseling Information

After repeated injections with OZURDEX®, a cataract may occur. If this occurs, your vision will decrease and you will need an operation to remove the cataract and restore your vision. You may develop increased eye pressure with OZURDEX® that will need to be managed with eye drops, and rarely, with surgery.

In the days following injection with OZURDEX®, you may be at risk for potential complications including in particular, but not limited to, the development of serious eye infection or increased eye pressure. If your eye becomes red, sensitive to light, painful, or develops a change in vision, you should seek immediate care from your eye doctor. You may experience temporary visual blurring after receiving an injection and should not drive or use machinery until your vision has resolved.

Please click here for full Prescribing Information.