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Xeomin Patient Co-Pay Program
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PO Box 4280
Gaithersburg, MD 20898
Phone
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888-493-6646
Fax:
866-471-3005
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Eligibility
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This is a copay assistance program for patients that have private insurance. Patients may not have Medicare Part D or have public insurance. There are no income limits for this program. Massachusetts residents are not eligible. |
| Who Can Apply
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Anyone interested can call for an application. |
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Required
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Doctors must complete and sign the application. Patients must complete, sign and attach insurance information to the application and fax or mail it in. |
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Supply
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N/A |
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Ship To
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N/A |
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Note
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This is a reimbursement program. The patient pays for medication and procedures and then is sent a Mastercard with the reimbursement amount which can be used anywhere Mastercard is accepted.
Contact program for Spanish application. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Xeomin injection |
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