Eligible patients may pay as little as $0 for OZURDEX®
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
- 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.
- Select either Comprehensive Program Support OR OZURDEX® Savings Program only. Enter patient information.
- 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.
- 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.
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.
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.
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?
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
- Prior to OZURDEX® injection, determine the patient’s out-of-pocket cost.
- 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.
- Allergan EyeCue® will send you an email to confirm whether the submission is approved or denied.
- 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