Financial Assistance Programs

Introducing the new XEOMIN® (incobotulinumtoxinA) Patient Savings Program

Support for Your Patients

The New XEOMIN® (incobotulinumtoxinA) Patient Savings Program

  • The XEOMIN® Patient Savings Program is designed to support eligible patients with their actual out-of-pocket XEOMIN medication costs and related administration fees, up to a maximum amount of $3,500 per rolling 12-month period. The initial 12-month period begins with a patient’s acceptance into the Program (no earlier than July 1, 2016).
  • See how we can help support appropriate patient access to XEOMIN therapy. Download an electronic brochure here.

  • 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
    • Not be enrolled in or eligible for Medicare, Medicare Advantage, Medicaid, Managed Medicaid, TRICARE (i.e., CHAMPUS), or other state or federally funded insurance plans 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

Merz North America, Inc. reserves the right to modify or discontinue any and all aspects of the program at any time and without notice.

Further restrictions apply to eligibility and reimbursable expenses. Please see full terms and conditions below or call 1-888-4-XEOMIN (1-888-493-6646), Option 2.

How It Works


Benefits demonstration: Mary Smith, Age 56

  • Diagnosed with cervical dystonia 12 months ago
  • Commercially insured but had the following out-of-pocket costs associated with her XEOMIN medication and related administration fees over the course of the year:
    • Treatment 1: $1,800 (higher initial expenses due to deductible)
    • Treatment 2: $600 (co-insurance responsibility for the procedure)
    • Treatment 3: $600 (co-insurance responsibility for the procedure)
    • Treatment 4: $0 (met the out-of-pocket max for the year, so procedure paid in full)
  • Patient stated the financial burden may delay her follow up treatment
  • Patient referred to the XEOMIN® Patient Savings Program. Assuming treatment costs remain the same and patient meets eligibility requirements, the Program will cover all of her out-of-pocket XEOMIN medication costs and related administration fees over the 12-month period following program enrollment††
  • Patient no longer has to delay XEOMIN therapy due to financial constraints

Please see full terms and conditions. Please see the XEOMIN® Patient Savings Program Information page for complete details and to download an application. Patients who move from commercial insurance coverage to federally or state-funded programs will no longer be eligible for the program.

Patients must sign and date a XEOMIN® Patient Savings Program Application and must re-enroll every 12 months.

Merz North America, Inc. reserves the right to modify or discontinue any and all aspects of the program at any time and without notice.

Illustration of savings program benefits. Not a real patient.
††Example calculation for illustrative purposes. Patient benefits will vary depending on their specific commercial insurance plan.

Eligibility, Terms and Conditions, and Program Limitations

From and after July 1, 2016, the Program covers eligible patients’ actual out-of-pocket XEOMIN medication costs and related administration fees up to a maximum amount of $3,500 per 12 month period beginning with patient’s acceptance into Program (no earlier than July 1, 2016).  The Program does not cover (a) office visit co-pays not directly associated with XEOMIN treatment; (b) facility co-pays not directly associated with XEOMIN treatment; or (c) any other costs excluded by the Program guidelines not specifically mentioned herein, which are subject to change.  Prior Program benefits and limitations apply up to and through June 30, 2016.

Eligible patients must be clinically appropriate patients for therapeutic treatment with XEOMIN.  Patient must be prescribed XEOMIN. Eligible patients must be at least 18 years of age.

This offer is valid only in the United States, excluding where it is otherwise prohibited by law.  Patients residing in the states of Massachusetts, Michigan, Rhode Island, and Minnesota are eligible for drug co-payment assistance only and are not eligible for other types of co-payment assistance, including but not limited to costs related to administration of the drug.

Eligible patients must have private commercial insurance that covers medication costs for XEOMIN, and acceptance of this offer must be consistent with the terms of that insurer’s drug benefit.  Eligible patients must not have coverage for XEOMIN through Medicare, Medicare Advantage, Medicare Part D, Medicaid, Medigap, TRICARE, Veterans Affairs (VA), the Department of Defense (DoD), or other federally funded or state funded healthcare programs.  Patients who move from commercial to federally funded or state funded insurance will no longer be eligible for the Program.  Proof required for receiving payment for out of pocket drug costs must be a valid explanation of benefits (EOB) or specialty pharmacy invoice, which must be submitted within 120 days after each treatment.

Patient may not seek reimbursement for value received from the Program from any third-party payers, including flexible spending accounts or healthcare savings accounts.  If at any time patient begins receiving coverage under any federal, state or government funded healthcare program, Patient is no longer eligible to participate in the Program and must call 1-888-4XEOMIN (1-888-493-6646) between 8 AM and 8 PM (EST) to stop participation.  Restrictions may apply. This is not health insurance.

Patient and patient’s pharmacist are responsible for notifying insurance carriers or any other third party who pays for or reimburses any part of the prescription filled using the Program as may be required by the insurance carrier’s terms and conditions and applicable law.

Enrollment in the Program may be reviewed on an annual basis to determine continued eligibility. This offer may not be combined with any other coupon, discount, prescription savings card, free trial, or other offer for XEOMIN.

This is a limited time offer, and Merz reserves the right to rescind, revoke, amend, or terminate this offer, or the program in its entirety, at any time, without notice.