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Patient Assistance Information

Xeomin Patient Co-Pay Program

PO Box 4280
Gaithersburg, MD 20898
Phone : 888-493-6646
Fax: 866-471-3005
> 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
> Anyone interested can call for an application.
> Doctors must complete and sign the application. Patients must complete, sign and attach insurance information to the application and fax or mail it in.
> N/A
Ship To
> N/A
> 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.
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.
Xeomin injection