How should practices submit requests to the program?
Practices can submit a co-pay request by first filling out the Physician Reimbursement Application. Practices can also check the co-pay attestation box that confirms the patient has paid at least $50 for OZURDEX® per eye per treatment. Practices should then upload the HCFA/CMS 1500, Explanation of Benefits (EOB) documentation, and Purchase Charge Documentation (Patient's Invoice for OZURDEX® Treatment) via the OZURDEX® Savings Portal. If the practice checks the Physician Attestation box, there is no need to also submit the Purchase Charge Documentation or sign the Physician Attestation form. The reimbursement request can also be submitted by faxing the patient’s supporting documents to 1-347-630-0347. Please include the patient's member ID on the fax cover sheet. Requests must be submitted within 120 days following administration.
How can I verify that the patient has paid at least $50 in co-payment for OZURDEX® per eye per treatment?
The physician's office has 3 options. It can check the Physician Attestation box on the reimbursement form, it can upload a signed Physician Attestation form, or it can upload a copy of the Purchase Charge Documentation (Patient's Invoice indicating they have paid at least $50 in co-payment for OZURDEX® per eye per treatment). If the practice wants to fax these materials instead of using the online upload form, they may fax it to 347-630-0347. Please include the patient's member ID on the fax cover sheet.
Does the program cover bilateral use?
Yes, the same member ID can be used for bilateral injection. The office should charge a minimum of a $50 co-pay for each eye (for a total patient out-of-pocket cost minimum of $100). The maximum benefit per treatment per eye is $1000.
When should HCPs submit supporting materials?
HCPs must submit the supporting materials within 120 days of the treatment date to be eligible for reimbursement.
What if my patient has both primary and secondary commercial insurance?
The eligible patient's insurance coverage should be exhausted before a request is submitted to the program. For example, if a patient has primary and secondary insurance, first submit a request to the primary insurer, then a secondary request to the secondary insurer, and then a reimbursement request along with both EOBs to the OZURDEX® Savings Program.
How long will it take for the program to process requests?
Once the patient's EOB and co-pay request are submitted, practices can usually expect to be reimbursed within 4 to 6 weeks. Physicians or office staff may call 1-855-454-6369 to inquire as to the status of an application.
Will the physician receive confirmation of patient eligibility and reimbursement after submission?
Yes, the physician and/or physician's office will receive email confirmation of patient eligibility and reimbursement once the reimbursement has been processed if the correct email address is provided on the enrollment form. Physicians or office staff may also call 1-855-454-6369 to inquire as to the status of an application.
Can patients get treatment from more than one doctor's office?
Yes. A patient must reenroll for each administration of OZURDEX® and should present their member ID to the treating physician or office staff.
Does the per-treatment maximum benefit change if a patient has bilateral disease?
Yes, patients can receive up to $1000 of co-pay benefit per treatment per eye.
Will applying for this program affect the patient’s credit score or FICO rating?
No, the request for credit information will not impact the patient’s credit score.
Are Massachusetts residents eligible?
Yes, Massachusetts residents are eligible for the program.
What if my patient has specialty pharmacy coverage?

The specialty pharmacy is assigned by the patient's insurance company and is most often a mail order pharmacy. Their medication may require permission from their insurance company known as a prior authorization. The information requested from you and your office can include blood work, specific test results, and other medications that have been tried for their condition. The authorization process can take anywhere from a few hours up to several days, sometimes longer, depending on the information needed and how quickly your office can provide it. Once they have the information, the insurance company will either approve or deny their prescription to be filled.

If the patient’s medication is approved, the patient should provide the specialty pharmacy with their insurance information and co-pay card information from the OZURDEX® Savings Program. Their medication may need to be shipped to their home, your doctor’s office, or in a few cases, a local pharmacy.

If the patient’s medication is denied, their doctor’s office has the ability to appeal the insurance company’s decision and explain why this particular medication is necessary. The patient may also be eligible for assistance through Allergan EyeCueSM.

Is there another way to apply for the program other than the OZURDEX® Savings Program website?
Yes, the physician's office can fax over the patient's information in these forms to 1-347-630-0347 with a cover letter addressed "Attn: Truveris." Download Reimbursement Form
How do I help re-enroll my patient in the OZURDEX® Savings Program?

Patients must re-enroll in the OZURDEX® Savings Program 1 year from the date their Member ID was issued. Patients can re-enroll in the program in one of two (2) ways:

Patients will receive a link 30 days prior to the expiration of their ID card to the email address provided on their prior year's enrollment form. Patients may click the link to be directed to a page to confirm their identity. Once a patient confirms their identity, certain information will be prepopulated on the re-enrollment form. If the patient continues to be eligible for the program, they will receive a Member ID via the website and via the email they provided on their enrollment form.

Patients may also re-enroll by going to the OZURDEX® Savings Program homepage. Patient should click "Enroll and get Member ID" and then click "I am a re-enrolling patient" to begin the process for re-enrollment.