XEOMIN® (incobotulinumtoxinA) Patient Savings Program

FREQUENTLY ASKED QUESTIONS: Program Transition

FREQUENTLY ASKED QUESTIONS: Program Transition

To download a copy of the Program Transition FAQs, please click here.

What are the eligibility requirements?

  • To be eligible, patients must:
    • Be a clinically appropriate patient for therapeutic treatment with XEOMIN, as
      determined by their doctor
    • Be prescribed XEOMIN
    • Be at least 18 years of age
    • Have commercial insurance that covers XEOMIN medication costs
    • Not be enrolled in a state or federally funded prescription insurance program.
      This includes patients enrolled in Medicare, Medicare Advantage, Medicare Part D,
      Part B, Medicaid, Medigap, TRICARE, Veterans Affairs (VA), the Department of
      Defense (DOD) or other federally funded or state funded healthcare programs, as
      well as patients who are Medicare eligible and enrolled in an employer-sponsored
      group waiver health plan or government subsidized prescription drug benefit
      program for retirees. If a patient is enrolled in a state or federally funded
      prescription insurance program, they are not eligible even if they elect to be
      processed as an uninsured (cash-paying) patient
  • Note that Merz reserves the right to change Program Terms and Conditions, including the
    eligibility requirements, at any time.
  • For additional information regarding Program Terms and Conditions, please visit the
    XEOMIN.com website at http://www.xeomin.com/consumers/patient-resources/
    patient-savings-program/

When will this change occur?

  • Enrollment Start Date: Patients may begin enrolling in this Program anytime after May 30, 2016
  • Program Start Date: The new offer is effective for eligible dates of service on or after July 1, 2016

If I’m already enrolled in the current Program, do I have to re-enroll in the new Program?

  • Yes. To be eligible to participate, you must enroll in the new XEOMIN® Patient Savings Program.
  • All treatments that take place on or before June 30, 2016, will be processed and administered under the current Program. Treatments on or after July 1, 2016 will be processed and administered under the newly enhanced Program.

How do I enroll in the Program?

  • We have included a XEOMIN® Patient Savings Program Enrollment Application along with this letter. Complete the application, sign and date it, and mail or fax it to the location listed below. We’ll take care of the rest!

    • The XEOMIN® Patient Savings Program
      PO Box 7017
      Bedminster, NJ 07921
      Fax # 1-844-711-6236
  • You can download an application from XEOMIN.com by visiting: http://xeomin.com/wp-content/uploads/xeomin-savings-application.pdf

If I have a XEOMIN injection scheduled between now and June 30, 2016, am I eligible for the new offer?

  • No. XEOMIN injections received on or after July 1, 2016 are eligible for the new
    Program/offer. If you are enrolled in the current XEOMIN® Copay Program and
    receive an injection on or before June 30, 2016, you can still request
    reimbursement support under the current Program, which offers reimbursement
    assistance of up to $500 per injection for eligible expenses.

My injection is scheduled before July 1. I won’t receive an Explanation of Benefits from my insurance carrier until after July 1. Will I still be eligible to receive reimbursement? And if so, will I be reimbursed under the current Program terms or the new Program terms?

  • If you are enrolled in the current Program, you will still be eligible to receive
    reimbursement for your XEOMIN injections that occur on or before June 30, 2016.
    To request reimbursement, please mail or fax your Explanation of Benefits and/or
    Specialty Pharmacy receipt within 120 days of your date of service to:


    • The XEOMIN Patient Co-pay Program
      PO Box 4280
      Gaithersburg, MD 20885-4280
      Fax # 1-866-471-3005
  • Please note: your Debit Card will no longer be active after June 30, so any
    reimbursements approved after that date will be paid via a check and mailed to
    your home. Please allow up to 30 days for this check to be processed and mailed.
  • Any injections occurring on or before June 30, 2016 will be reimbursed under the
    current Program terms, meaning you may be eligible to receive reimbursement of
    up to $500 for the cost of the XEOMIN medication and any associated
    administration fees.

I have already received reimbursement under the current Program this year. Will the amount I have received under the current Program affect the amount of reimbursement support for which I am eligible to receive under the new Program?

  • No. The amount of reimbursement you have received under the current Program
    will have no impact on the reimbursement cap of $3,500 that you may be eligible
    to receive under the new Program. The initial 12 month period for the new
    Program begins with your acceptance into the Program (no earlier than July 1,
    2016).

I am not currently enrolled in the XEOMIN® Copay Program. I have an injection scheduled before June 30, 2016. Am I still eligible to enroll in the current program?

  • Yes, you can still enroll in the current XEOMIN® Copay Program to determine if you
    are eligible to receive reimbursement assistance of up to $500 per injection
    towards your XEOMIN medication and related administration fees. This Program
    is effective for any dates of service on or before June 30, 2016.
  • To determine if you are eligible for the current Program, complete and submit this
    enrollment application (http://xeomin.com/wp-content/uploads/xeomin-copay-application.pdf),
    receive your XEOMIN injection, submit your EOB and/or Specialty
    Pharmacy receipt, and if your claim is approved, you will receive your Program
    reimbursement via check.

My debit card isn’t working, whom should I contact?

  • For questions regarding your debit card on or before June 30, 2016, please call 1-
    877-411-8641
  • Your debit card will be de-activated on June 30, 2016. Any remaining funds left on
    the card as of that date will be sent directly to you in the form of a check. Please
    allow up to 30 days for this check to be processed and mailed.
  • If you have questions regarding your debit card after June 30, 2016, please call 1-
    888-4-XEOMIN (1-888-493-6646) option 2

What happens if I still have money left on my debit card?

  • Your debit card will be de-activated on June 30, 2016. Any remaining funds left on
    the card as of that date will be sent directly to you in the form of a check. Please
    allow up to 30 days for this check to be processed and mailed.

Who do I contact if I have a question regarding my debit card balance?

  • For questions regarding your debit card balance on or before June 30, 2016, please
    call 1-877-411-8641
  • All Program Debit Cards will be deactivated on June 30, 2016. For any Program
    questions after that date, please call 1-888-4-XEOMIN (1-888-493-6646) option 2

Is anything staying the same under the new Program?

  • You will still be enrolled in the Program for 12 months at a time, so you will still
    need to re-enroll every 12 months to maintain your eligibility.
  • You or your physician will still need to send in an Explanation of Benefits (EOB)
    and/or Specialty Pharmacy receipt to the Program to determine if you are eligible
    for reimbursement.