Bausch + Lomb is committed to providing savings and reimbursement support for XIPERE®

XIPERE Savings Program

If you have commercial insurance, you may be eligible* to pay as little as a $0 copay with
the XIPERE Savings Program. Visit the Savings Website to find out if you qualify. Visit Savings Website Xipere

Bausch + Lomb offers reimbursement support through the FOCUS ON ACCESS (FOA) Program. Your doctor may work with this support program to determine your coverage options for XIPERE. If so, here's how it works:

  1. After your doctor determines that XIPERE® is right for you, their office staff may work with a FOCUS ON ACCESSTM (FOA) Representative to complete a Patient Information and Enrollment form for you. Your doctor will ask you to sign the patient authorization section of the form.
  2. Within 24 hours, an FOA representative will contact your insurance company to determine your health insurance benefits and coverage for XIPERE. They will also determine if you may be eligible to pay as little as a $0 copay through the XIPERE Savings Program.
  3. Then, a FOA representative will call you to explain your insurance coverage and discuss cost support options with you such as the XIPERE Savings program.
  4. Once that is completed, you can then schedule your first XIPERE treatment.
  5. After that, you can continue to utilize FOA for support as needed, in case your insurance changes.

*Terms, Conditions and Limitations Apply. Your doctor can refer you to the FOCUS ON ACCESS program to determine your eligibility for patient assistance. Insurance plans and coverage are subject to change. Bausch + Lomb does not guarantee coverage or reimbursement for the product.

Next step for reimbursement

Fill out this form and bring it to your appointment.

Download FOA Enrollment Form Xipere

Contact Your FOA Representative to Get Answers Today

FOCUS ON ACCESS

1-866-272-8838

Monday – Friday 9:00 AM to 5:00 PM ET

Contact Your FOA Representative to Get Answers Today

FOCUS ON ACCESS

1-866-272-8838

Monday – Friday | 9:00 AM to 5:00 PM ET

Next step for reimbursement

Fill out this form and bring it to your appointment.

FAQs About Coverage and Reimbursement

  • If a claim is denied, an FOA counselor will assist you with information concerning the claim-appeal process
  • You may also be considered for the Patient Assistance Program
  • You may be eligible based on:
    • Lack of access to product prescribed
    • Documentation of household income
    • Proof of US residency
  • You need to fill out the Patient Information section of the FOA enrollment form
  • Your doctor will provide you with this form
  • The form will instruct you what information you need to supply
  • Submit your filled out enrollment form with the necessary documents by mail or fax to:
FOCUS ON ACCESS PROGRAM
PO Box 220662
Charlotte, NC 28222-0662

FAX: (866) 272-8839
Please note: Faxed enrollment forms are acceptable.

Enrollment period maximum benefit caps apply. Patients may pay out of pocket costs if enrollment period maximum benefit caps are met. Please note: This program only helps with the cost of the drug and does not cover the cost of the procedure.

Eligibility Criteria/Terms and Conditions:

By using the XIPERE copay savings program, you confirm that you understand and agree to comply with the following terms and conditions of this offer:

  • This offer is valid for 12 months from the patient enrollment date.
  • Reimbursement limitations apply. Patient is responsible for all additional costs and expenses after reimbursement limits are reached, including additional copayment and coinsurance amounts.
  • This offer is only valid for eligible patients with commercial insurance and coverage.
  • This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs.
  • This coupon shall be applied only toward the patient out of pocket cost for the product and not toward ancillary services or treatment costs.
  • You agree not to seek reimbursement for all or any part of the benefit received through this offer and are responsible for making any required reports of your use of this offer to any insurer or other third party who pays any part of the prescription filled.
  • This offer is good only in the United States of America (including the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands).
  • This offer is not valid for any person who is 65 years of age or older without commercial insurance and coverage for the product. You must be 18 years of age or older to redeem this offer.
  • This coupon is good for use only with the products identified herein. No other purchase is necessary.
  • This offer is not valid where prohibited, taxed or otherwise restricted.
  • This offer is not valid for redemption in the States of California and Massachusetts or by any resident of the States of California or Massachusetts with regard to any product for which a therapeutically equivalent generic product is available.
  • This offer cannot be redeemed at government-subsidized clinics.
  • This coupon and offer are not health insurance.
  • The selling, purchasing, trading, or counterfeiting of this coupon is prohibited by law. Void if reproduced.
  • This offer is not valid with other offers. This coupon has no cash value. No cash back.
  • Bausch + Lomb reserves the right to rescind, revoke, terminate, or amend this offer at any time, without notice.
  • This offer expires December 31, 2022.

If you are not eligible for the XIPERE Savings Program, there may be other options for co-pay assistance. Call 866-272-8838 to speak to a FOCUS ON ACCESS™ Representative or visit www.xipere.com to learn more.

 

Indication

XIPERE® (triamcinolone acetonide injectable suspension) is a corticosteroid used to treat macular edema associated with an eye disease called uveitis.

Important Safety Information

  • Your eye doctor will monitor you for elevated eye pressure following treatment and manage it with medication or surgery if required.
  • See your eye doctor right away if your eyes become red, sensitive to light or painful, or if you notice changes in vision.
  • XIPERE is not appropriate for use in patients with eye infections. It should be used with caution in patients with a history of herpes simplex in the eye.
  • XIPERE is not appropriate for use in patients with a known allergy to triamcinolone acetonide or any other components of this product.
  • Use of corticosteroids such as XIPERE may produce cataracts, increased eye pressure and glaucoma, and may increase the likelihood of eye infections.
  • Patients being treated with XIPERE for extended periods of time will be monitored for problems with the body’s hormonal system, which controls the ability to respond to stress.
  • In clinical studies, the most common eye-related side effects were increased eye pressure and eye pain. Other side effects included cataract, floaters or flashes of light, injection site pain, burst blood vessels, reduced or blurred vision, dry eye, light sensitivity, redness, infection, swelling, watery eyes, eye or eyelid irritation, bumps on the eyelid, itchy eyes, and drooping eyelid.

The most common non-eye-related side effect was headache.

  • Corticosteroids should be used during pregnancy or nursing only if the potential benefit justifies the potential risk to the fetus or nursing infant. Talk to your eye doctor.

To report SUSPECTED ADVERSE REACTIONS, contact Bausch + Lomb at 1-800-321-4576 or FDA at 1-800-FDA 1088 or visit www.fda.gov/medwatch.

Please click here for full Prescribing Information.

Indication

Important Safety Information

XIPERE® (triamcinolone acetonide injectable suspension) is a corticosteroid used to treat macular edema associated with an eye disease called uveitis.

Important Safety Information

  • Your eye doctor will monitor you for elevated eye pressure following treatment and manage it with medication or surgery if required.
  • Your eye doctor will monitor you for elevated eye pressure following treatment and manage it with medication or surgery if required.