Note: This is a drug discount program, not an insurance plan. We comply with the HONcode standard for trustworthy health information. *Data on File, October 2010April 2020. . Based on insurance coverage, reimbursement may be up to $1000 per treatment with a maximum savings limit of $4000 per year; patient out-of-pocket expense may vary. Fax Fax the correct referral form with the following: Copy of both sides of the insurance card Copies of patient clinical information, including lab values Patient chart notes from the last 2 weeks, including current weight that may affect dosing In pediatric patients treated with BOTOX for lower limb spasticity, upper respiratory tract infections were not reported more frequently than placebo. The dose of BOTOX and BOTOX Cosmetic is not the same as, or comparable to, any other botulinum toxin product. OPUS Health pioneered the co-pay assistance space! Offer not valid for (a) patients enrolled in Medicare, Medicaid, TRICARE or any other government-reimbursed healthcare program (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse for the entire cost of prescription drugs; (b) patients who are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees; (c) cash-paying patients. Allergan reserves the right to rescind, revoke, or amend this offer without notice. Offer does not constitute health insurance. Adult patients treated for overactive bladder due to neurologic disease: In clinical trials, 30.6% of adult patients (33/108) who were not using clean intermittent catheterization (CIC) prior to injection, required catheterization for urinary retention following treatment with BOTOX 200 Units as compared to 6.7% of patients (7/104) treated with placebo. The risk of developing lung disease in patients with reduced lung function is increased in patients receiving BOTOX. No information on this site is provided with the intention to give medical advice or instructions on the accurate use of Allergan products. The program gives access to some of the largest copay assistance programs available also while encouraging retail pharmacies to offer copay coupon programs to customers when they need it . CVS Specialty accepts money orders by mail only. Call for most recent medications as the list is subject to change. Name * Email * Phone * Preferred Method of Contact * Message * Include Attachment . BOTOX has not been shown to help people perform task-specific functions with their upper limbs or increase movement in joints that are permanently fixed in position by stiff muscles. Claims must be submitted within 180 days of treatment date and must include a copy of (a) an Explanation of Benefits (EOB) for the BOTOX treatment, (b) a Specialty Pharmacy (SP) receipt for BOTOX, or (c) other writing showing payment of out-of-pocket BOTOX and treatment-related out-of-pocket costs. Weve updated our Terms and Conditions. Copay assistance or drug manufacturer debit cards may be accepted by calling the Billing department at 1-800-250-9631 (TTY: 711). We can help you find co-pay information and resources. That's why we offer patient assistance programs that provide free AbbVie medicines to qualifying patients. Autonomic dysreflexia in patients treated for overactive bladder due to a neurologic disease. 11. Eligibility and other restrictions apply. Questions? All rights reserved. Central Nervous System. It is not known if BOTOX Cosmetic is safe and effective for use more than 1 time every 3 months. Blepharospasm, Cervical Dystonia, Chronic Migraine, and others. This is not health insurance. Program Terms, Conditions, and Eligibility Criteria: 1. Indications BOTOX is a prescription medicine that is injected into muscles and used: To treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away AMPYRA Patient Support Services (APSS):Step-by-Step Assistance for AMPYRA (dalfampridine) Coverage. Tell your doctor if you have any breathing-related problems. American Optometric Association. 4. Offer subject to change or discontinuance without notice. Optometric Clinical Practice Guideline: Care of the Patient with Strabismus: Esotropia and Exotropia. 2. Proven experience in over 25 therapeutic areas. Cornea (surface of the eye) problems have been reported in some people receiving BOTOX for their Blepharospasm, especially in people with certain nerve disorders. . Easily manage your medications and track your orders online using the myCigna app or website.4. The BOTOX Savings Program offers money back in the form of a check sent to eligible members. Do not receive BOTOX if you are allergic to any of the ingredients in BOTOX (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc (rimabotulinumtoxinB), Dysport (abobotulinumtoxinA), or Xeomin (incobotulinumtoxinA); have a skin infection at the planned injection site. Co-Pay Relief Program 421 Butler Farm Road Hampton, Virginia 23666. I am receiving coverage through Medicare. Aug 25, 2014, 08:30 ET. BOTOX may cause the eyelids to blink less, which could lead to the surface of the eye being exposed to air more than is usual. Allergan cannot answer unsolicited emails requesting personal medical advice; visitors should always consult a healthcare professional. $166,500 or less. Healthcare Professionals . You will . BOTOX may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of receiving BOTOX. Online Discount Pharmacy Remember, only a doctor can determine if BOTOX is right for you, too. Implemented and managed over 1,000 programs. After 4, add $28,320 for each additional dependent family member. 7. All I pay out of pocket is for my actual doctor visit, which is my copay. Contacts for Medical Information: For legacy Allergan products: 1-800-678-1605. Offer not valid for (a) patients enrolled in Medicare, Medicaid, TRICARE or any other government-reimbursed healthcare program (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse for the entire cost of prescription drugs; (b) patients who are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees; (c) cash-paying patients. Offer valid only for BOTOX and BOTOX treatment-related costs not covered by insurance. Visit Website, More information please phone: Please see BOTOX Cosmetic full Product Information, including Boxed Warning and Medication Guide. Allergan reserves the right to rescind, revoke, or amend this offer without notice. Follow the texting prompts to JOIN. Adult patients treated for overactive bladder due to a neurologic disease: To treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency), and urinating often (frequency) in adults 18 years and older . 9. my AbbVie Assist Patient Assistance Program. This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. I have always said because BOTOX does work for me, that I would pay for my BOTOX out of pocket if it was not covered by my health insurance. Allergan, Inc., an AbbVie company, is the maker and marketer of BOTOX (onabotulinumtoxinA). The selection of a physician is an important decision that should not be based solely on the inclusion in this physician locator directory. Click No information on this site is provided with the intention to give medical advice or instructions on the accurate use of Allergan products. Based on insurance coverage, reimbursement may be up to $1000 per treatment with a maximum savings limit of $4000 per year; patient out-of-pocket expense may vary. * Resources include referrals to independent nonprofit patient assistance programs. Form more information phone: 888-912-1572 or Please note that the Botox Savings Program covers the cost of the product and out-of-pocket costs for the injection but does not cover any associated . If this happens, do not drive a car, operate machinery, or do other dangerous activities. If you have any questions about this site that have not been answered, click here. * Confirm Password* New Account Registration . Some offers may be printed right from a website, others require registration, completing a questionnaire, Claims must be submitted within [XXX] days of treatment date and must include a copy of (a) an Explanation of Benefits (EOB) for the BOTOX treatment, (b) a Specialty Pharmacy (SP) receipt for BOTOX, or (c) other writing showing payment of out-of-pocket BOTOX and treatment-related out-of-pocket costs. Show More. You are encouraged to report negative side effects of prescription drugs to the FDA. Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Digital Support; Patient support for Accredo.com and Accredo mobile app. The free Drugs.com Discount Card works like a coupon and can save you up to The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Other side effects of BOTOX include dry mouth; discomfort or pain at the injection site; tiredness; headache; neck pain; eye problems such as double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, dry eyes; drooping eyebrows; and upper respiratory tract infection. Botox (onabotulinumtoxinA) It is not known whether BOTOX and BOTOX Cosmetic are safe and effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine). I basically pay for the migraine specialist to administer the shots but everything else is covered. My copay is $30 but Shared Solutions pays my copay. It is free to apply, and those who qualify will receive their medicine for free no co-pays or shipping costs. The dose of BOTOX is not the same as, or comparable to, another botulinum toxin product. Offer good only with a valid prescription for BOTOX (onabotulinumtoxinA). 7am-10pm CT, Monday - Friday. In clinical trials, the incidence of autonomic dysreflexia was greater in adult patients treated with BOTOX 200 Units compared with placebo (1.5% versus 0.4%, respectively). The risk of developing lung disease in patients with reduced lung function is increased in patients receiving BOTOX. 11. For questions about the program, please call 1-800-44-BOTOX. 99% of commercial insurance plans cover the majority of BOTOX costs.,. Do not start any new medicines until you have told your doctor that you have received BOTOX in the past. Using BOTOX with certain other medicines may cause serious side effects. If we are unable to assist you with your out-of-pocket medical expenses, one of the following organizations* may be able to help: The Assistance Fund Cancer Care Good Days HealthWell Foundation Leukemia & Lymphoma Society . The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms, including loss of strength and all-over muscle weakness; double vision; blurred vision; drooping eyelids; hoarseness or change or loss of voice; trouble saying words clearly; loss of bladder control; trouble breathing; and trouble swallowing. To get started with texting, you will need: Your phone number; Date of Birth; Active Accredo prescription number . Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. You are encouraged to report negative side effects of prescription drugs to the FDA. 3. 12. Based on insurance coverage, reimbursement may be up to. 9. Based on insurance coverage, reimbursement may be up to $1000 per treatment with a maximum savings limit of $4000 per year; patient out-of-pocket expense may vary. Offer good only with a valid prescription for BOTOX (onabotulinumtoxinA). Void where prohibited by law, taxed, or restricted. Tell your doctor if you notice any new visual problems while For payment to be made to your healthcare provider, an authorized assignment of benefit also must be included with the Claim. Reference: 1. Learn how AbbVie can help you save on BOTOX for Chronic Migraine 2. 1-833-MyBV360 (692-8360) MyBV360.com Patient Assistance Program Form Bioventus is committed to providing access to SUPARTZ FX, GELSYN-3 and DUROLANE to patients without the financial resources to pay for the treatment by providing Patient Assistance Product at no cost. Patient assistance programs (PAPs) are usually sponsored by pharmaceutical companies and provide free or Fax or mail the completed application and documentation to: Allergan Patient Assistance Program PO BOX 66764, St. Louis, MO 63166 Phone: 1 844-424-6727 Fax: 1 844-708-0036 Upon receipt of a completed application, notification of eligibility will be sent to the Depending on the health insurance plan, savings may apply toward co-pay, co-insurance, or deductible. Please see BOTOX full Product Information, including Boxed Warning and Medication Guide. Provide the required information including your mobile phone number. If you are a healthcare provider whose practice is currently being shown on Find a BOTOX Specialist and you would like to opt out or update your profile information, please contact AcademyHelp@Allergan.com. 10. Offer does not constitute health insurance. Tell your doctor about all your muscle or nerve conditions, such as ALS or Lou Gehrigs disease, myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects, including difficulty swallowing and difficulty breathing from typical doses of BOTOX or BOTOX Cosmetic. . The Copay Assistance Program is designed to capture the available dollars from the manufacturers to reduce employee and plan sponsor costs. You currently do not meet all the requirements. Allergan reserves the right to rescind, revoke, or amend this offer without notice. This Botox price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies. Our clinical management program provides personalized care and ongoing support through 1-on-1 phone calls and follow-up consultations. Allergan cannot answer unsolicited emails requesting medical advice; visitors should always consult a healthcare professional. US-BTX-21159110/21 012756. 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