Copay relief for those who use a botulinum toxin for a movement disorder or cerebral palsy. Xeomin is a type A BTX but not Botox

• Co pay relief for those who use a botulinum toxin for a movement disorder or
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  cerebral palsy.
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•  Xeomin is a type A
•  BTX but not Botox - JR
• Link is here
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• Patient initiates the enrollment process by calling 1-888-4-XEOMIN (1-888-493-6646) or by faxing a XEOMIN® Patient Co-payment Program Application to 866-471-3005. Physician assists the patient in the enrollment process by verifying some of the required enrollment information (see Enrollment Form).

2. • After the patient’s application is reviewed and the program determines that he or she satisfies the enrollment requirements for participation in the Co-pay Program, the patient will receive a XEOMIN® Patient Co-payment Program Enrollment Letter. Patient should discuss treatment plan with his or her physician.

3. • Healthcare Provider administers XEOMIN® injection and submits claim for reimbursement for XEOMIN® to the patient’s insurance company according to the provider’s usual practice and procedure. The patient will pay his or her co-pay/coinsurance to the physician in an amount as determined by the patient’s insurance coverage/policy and the Provider’s usual co-payment collection practices.

4. • Patient sends Explanation of Benefits (EOB) or specialty pharmacy shipment invoice to XEOMIN® Patient Co-payment Program by faxing to 866-471-3005 or mailing to The XEOMIN® Patient Co-payment Program: PO Box 4280 Gaithersburg, MD 20885-4280 within 120 days of injection date.

A Co-pay Program debit MasterCard, loaded with funds in the amount of the patient’s eligible out of pocket costs as determined by the Co-payment Program guidelines, is mailed directly to the patient’s home. To be eligible, a patient must be an appropriate patient for XEOMIN^® treatment, as determined by their physician, have commercial insurance that covers XEOMIN^® treatment, etc. and may include the cost of XEOMIN, associated guidance therapy, and related administration fees (“eligible costs”). Patients may use the card wherever debit MasterCards are accepted, including healthcare providers.

The program terms and conditions limit the amount of out-of-pocket costs that can be reimbursed to patients per XEOMIN® treatment.

The per treatment out-of-pocket cost limit is $500 or the amount of the patient's Co-pay/coinsurance, whichever is less. The following eligible costs associated with XEOMIN treatment will be reimbursable directly to the patient up to the above limit:

• Any eligible costs specifically associated to the patient's deductible
• Any co-pay specifically associated to eligible costs
• Any coinsurance costs specifically associated to eligible costs

The following costs are not eligible and will not be reimbursable:

• Office visit co-pays not directly associated with the Xeomin treatment
• Facility co-pays not directly associated with the Xeomin treatment
• Any other costs excluded by the Co-pay Program guidelines (e.g. not specifically mentioned above), which are subject to change.