Ozurdex

How the OZURDEX® Savings Program Works

Eligible patients may pay as little as $0 for OZURDEX®

Eligibility Requirements

Patients must meet the following criteria:

  • 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
  • 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

How to Enroll Your Patients

  1. Log in to the Allergan EyeCue® portal to open a case. If you have not established a username and password, please proceed to set one up.
  2. Select either Comprehensive Program Support OR OZURDEX® Savings Program only. Enter patient information.
  3. Complete the 3-page enrollment form and obtain patient signatures on pages 2 and 3. Upload all pages of the enrollment form to the Allergan EyeCue® portal or fax to 1-866-676-4069.
  4. Allergan EyeCue® will email to confirm or deny patient eligibility. The results can be found on the benefit verification summary. If approved, you will also receive the patient member ID via email. It will also be saved under the patient case information in the Allergan EyeCue® portal.

ELIGIBILITY

What is the benefit design of the OZURDEX® Savings Program?

After March 1, 2021, the patient may pay as little as $0 per treatment until the annual cap of $5000 in benefits is reached. After the $5000 benefit, the patient will be responsible for their out-of-pocket costs as stated by their payer. For dates of service before March 1, 2021, the patient may pay as little as $50 per treatment until the annual cap of $1000 in benefits is reached.


Enrollment

How do I enroll patients in the OZURDEX® Savings Program?

Enrollment in the OZURDEX® Savings program is now done using the same enrollment form that is used to conduct a benefit verification through Allergan EyeCue®. The new enrollment form is 3 pages and requires both patient and provider signatures.

Is there an editable PDF version of the new enrollment form that an office can fill out and have patients sign?

Yes, you can download the form at AllerganEyeCue.com, or you can get copies from your Reimbursement Business Advisor. On the Allergan EyeCue® homepage, if you click on the blue menu icon in the upper-right corner and select Support in the drop-down, you can access this through the Resources button.

Can patients enroll themselves in the OZURDEX® Savings Program?

No. Patients cannot register on their own. Only providers can register patients, which is done online at AllerganEyeCue.com or through the paper enrollment form, which should be filled out by the office.

If a clinic only wants to enroll a patient in the OZURDEX® Savings Program, is a patient’s signature required on both pages (pages 2 and 3)?

Both pages are required. They need to be signed and submitted for all patients. The forms can be uploaded online at AllerganEyeCue.com or faxed in to Allegan EyeCue® at 1-866-676-4069.


Renewal

How often do I need to get signature for my patients?

Signatures are valid for 2 years.

After being approved for a year from the date of enrollment, is the patient automatically reenrolled in the Savings Program, or does the clinic need to enroll them again?

The clinic needs to reenroll the patient annually, which is done online at AllerganEyeCue.com. Your Reimbursement Business Advisor can walk through the process for reenrolling a patient through AllerganEyeCue.com.

What if a patient’s insurance has not changed? Do I need to reenroll the patient in the OZURDEX® Savings Program?

Yes, the patient needs to be reenrolled.

How Your Office Requests Reimbursement

  1. Prior to OZURDEX® injection, determine the patient’s out-of-pocket cost.
  2. Log in to the Allergan EyeCue® portal. Search for the patient’s copay savings case and click the bold case ID number. Then, in the Copay Savings Program tab of the case detail summary, click Initiate a Claim. Then, upload the supporting documents: HCFA/CMS-1500 form, Explanation of Benefits, and Reimbursement Claims Form.

  3. Allergan EyeCue® will send you an email to confirm whether the submission is approved or denied.
  4. If approved, you will receive a reimbursement check within 2 to 4 weeks, or in 3 days if you selected ACH.

The reimbursement claims form must be signed by the physician, or a delegate authorized to sign on behalf of the physician, attesting that the patient received an OZURDEX® injection.

How do I submit a reimbursement request to Allergan®?

Reimbursement requests can be uploaded online at AllerganEyeCue.com or faxed to 1-866-676-4069. These requests must include the OZURDEX® Savings Program Physician Reimbursement Request Form, CMS-1500 Claim Form, and the Explanation of Benefits from the payer.

The OZURDEX® Savings Program Physician Reimbursement Form can be download at AllerganEyeCue.com, or you can get a printed copy from your Reimbursement Business Advisor.

How long do I have to submit reimbursement requests?

A practice has 180 days from the date of service to submit a reimbursement request to the OZURDEX® Savings Program.

How do I receive my reimbursement from OZURDEX® Savings Program?

Reimbursement is in the form of a mailed check. Electronic Funds Transfer (EFT) can also be selected as a preferred reimbursement method.

Can I mail in claims to the OZURDEX® Savings Program?

No. All claims must be uploaded to AllerganEyeCue.com or faxed to 1-866-676-4069. If you need the address to load into your billing system as a point of reference, the OZURDEX® Savings Program address is the following:

OZURDEX® Savings Program through IQVIA
77 Corporate Drive
Bridgewater, NJ 08807

Indications and Usage

Diabetic Macular Edema

OZURDEX® (dexamethasone intravitreal implant) is a corticosteroid indicated for the treatment of diabetic macular edema.

Retinal Vein Occlusion

OZURDEX® is a corticosteroid indicated for the treatment of macular edema following branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).

Posterior Segment Uveitis

OZURDEX® is indicated for the treatment of noninfectious uveitis affecting the posterior segment of the eye.

Dosage and Administration

FOR OPHTHALMIC INTRAVITREAL INJECTION. The intravitreal injection procedure should be carried out under controlled aseptic conditions. Following the intravitreal injection, patients should be monitored for elevation in intraocular pressure and for endophthalmitis. Patients should be instructed to report any symptoms suggestive of endophthalmitis without delay.

IMPORTANT SAFETY INFORMATION
Contraindications

Ocular or Periocular Infections: OZURDEX® (dexamethasone intravitreal implant) is contraindicated in patients with active or suspected ocular or periocular infections including most viral diseases of the cornea and conjunctiva, including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, and fungal diseases.

Glaucoma: OZURDEX® is contraindicated in patients with glaucoma, who have cup to disc ratios of greater than 0.8.

Torn or Ruptured Posterior Lens Capsule: OZURDEX® is contraindicated in patients whose posterior lens capsule is torn or ruptured because of the risk of migration into the anterior chamber. Laser posterior capsulotomy in pseudophakic patients is not a contraindication for OZURDEX® use.

Hypersensitivity: OZURDEX® is contraindicated in patients with known hypersensitivity to any components of this product.

Warnings and Precautions

Intravitreal Injection-related Effects: Intravitreal injections, including those with OZURDEX®, have been associated with endophthalmitis, eye inflammation, increased intraocular pressure, and retinal detachments. Patients should be monitored regularly following the injection.

Steroid-related Effects: Use of corticosteroids including OZURDEX® may produce posterior subcapsular cataracts, increased intraocular pressure, glaucoma, and may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses.

Corticosteroids are not recommended to be used in patients with a history of ocular herpes simplex because of the potential for reactivation of the viral infection.

Adverse Reactions

Diabetic Macular Edema

Ocular adverse reactions reported by greater than or equal to 1% of patients in the two combined 3-year clinical trials following injection of OZURDEX® for diabetic macular edema include: cataract (68%), conjunctival hemorrhage (23%), visual acuity reduced (9%), conjunctivitis (6%), vitreous floaters (5%), conjunctival edema (5%), dry eye (5%), vitreous detachment (4%), vitreous opacities (3%), retinal aneurysm (3%), foreign body sensation (2%), corneal erosion (2%), keratitis (2%), anterior chamber inflammation (2%), retinal tear (2%), eyelid ptosis (2%). Non-ocular adverse reactions reported by greater than or equal to 5% of patients include: hypertension (13%) and bronchitis (5%).

Increased Intraocular Pressure: IOP elevation greater than or equal to 10 mm Hg from baseline at any visit was seen in 28% of OZURDEX® patients versus 4% of sham patients. 42% of the patients who received OZURDEX® were subsequently treated with IOP-lowering medications during the study versus 10% of sham patients.

The increase in mean IOP was seen with each treatment cycle, and the mean IOP generally returned to baseline between treatment cycles (at the end of the 6-month period).

Cataracts and Cataract Surgery: The incidence of cataract development in patients who had a phakic study eye was higher in the OZURDEX® group (68%) compared with Sham (21%). The median time of cataract being reported as an adverse event was approximately 15 months in the OZURDEX® group and 12 months in the Sham group. Among these patients, 61% of OZURDEX® subjects versus 8% of sham-controlled subjects underwent cataract surgery, generally between Month 18 and Month 39 (Median Month 21 for OZURDEX® group and 20 for Sham) of the studies.

Retinal Vein Occlusion and Posterior Segment Uveitis

Adverse reactions reported by greater than 2% of patients in the first 6 months following injection of OZURDEX® for retinal vein occlusion and posterior segment uveitis include: intraocular pressure increased (25%), conjunctival hemorrhage (22%), eye pain (8%), conjunctival hyperemia (7%), ocular hypertension (5%), cataract (5%), vitreous detachment (2%), and headache (4%).

Increased IOP with OZURDEX® peaked at approximately week 8. During the initial treatment period, 1% (3/421) of the patients who received OZURDEX® required surgical procedures for management of elevated IOP.

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