SUPPORT SERVICES

Commited to You and Your Patients

Benefits Investigation

A full report, including insurance coverage, within 2 business days.

Claims Assistance

Helping address your questions up front. Receive coding and billing guidance before a claim is submitted, assistance with monitoring claims, clearly communicated results, and payment details.

Prior Authorization (PA) Assistance

If a PA is necessary, we provide access to helpful forms and assistance with payer requirements to facilitate approval.

Appeal Assistance

Individualized guidance on appeal submission and assistance with documentation and forms. We track the status of appeals and clearly communicate results and next steps.

Financial Assistance Programs

Assistance for all qualifying patients. DEXTENZA360 will help determine patient eligibility and investigate options.

DEXTENZA ASSISTANCE PROGRAMS

PATIENT ASSISTANCE PROGRAM (PAP)

Eligible patients may receive DEXTENZA® at no cost:

Program Eligibility Criteria


COMMERCIAL COVERAGE PATIENT ASSISTANCE

Financial assistance with out-of-pocket cots for qualifying patients:

Program Eligibility Criteria


PRODUCT REPLACEMENT PROGRAM FOR DAMAGED OR UNUSABLE PRODUCT

Product replacement for DEXTENZA inserts rendered unusable:

Program Eligibility Criteria

  1. Product is deemed unusable if:
    • The product was mishandled, dropped, or broken;
    • The product was inappropriately stored, refrigerated, or frozen;
    • The product is deemed not appropriate for administration before, during, or after the procedure.
  2. Product replacement request must be submitted 30 days from the date of incident.
PATIENT ASSISTANCE PROGRAM (PAP)

Eligible patients may receive DEXTENZA® at no cost:

  • Provides free product for financially eligible uninsured, government insured, and commercially insured patients with no payer coverage for DEXTENZA.

Program Eligibility Criteria

  • US resident with a legal US mailing address.
  • Annual income of <500% of federal poverty level adjusted for family size.
  • Enrolled in DEXTENZA360 by the healthcare provider or site of care.
  • DEXTENZA360 benefits verification determines patient does not have payer coverage for DEXTENZA.
  • Diagnosis that meets the product label requirements.
  • Submission of completed and signed application must be received at least 5 business days prior to date of surgery.
COMMERCIAL COVERAGE PATIENT ASSISTANCE

Financial assistance with out-of-pocket cots for qualifying patients:

  • For eligible patients with commercial insurance, Ocular Therapeutix covers the patient’s responsibility for DEXTENZA.
  • This program is not designed to cover underpayment, bundling or groupings.

Program Eligibility Criteria

  • US resident with a legal US mailing address.
  • Enrolled in DEXTENZA360 by the healthcare provider or site of care.
  • Must have a commercial insurance plan, not government insurance, i.e. Medicare, Medicaid, Medicare Advantage and TriCare.
  • Diagnosis that meets the product label requirements.
  • Benefit is capped at the Facility Acquisition Cost.
  • Underpayments, bundling and group claims do not qualify for this program.
  • Invoice must be included with request.
PRODUCT REPLACEMENT PROGRAM FOR DAMAGED OR UNUSABLE PRODUCT

Product replacement for DEXTENZA inserts rendered unusable:

  • Place a formal request with the Product Replacement Form, located on www.DEXTENZA.com or available from your local Field Reimbursement Manager.
  • FOR RETURNS OF EXPIRED PRODUCT OR PRODUCT DAMAGED IN SHIPMENT, please contact your distributor for return.

Program Eligibility Criteria

  • Product is deemed unusable if:
    • The product was mishandled, dropped, or broken;
    • The product was inappropriately stored, refrigerated, or frozen;
    • The product is deemed not appropriate for administration before, during, or after the procedure.
  • Product replacement request must be submitted 30 days from the date of incident.

MAKING SUPPORT CONVENIENT FOR YOU

Online

Visit DEXTENZA360.COM for 24/7 online access to interactive tools designed to help you throughout the access and reimbursement process.

Call

800-339-8369 (800-DEXTENZA) for your dedicated Case Manager

Monday-Friday 8:00 AM-8:00 PM ET

(Fax: 855-518-7564)

Connect

directly with your Ocular Therapeutix Field Reimbursement Manager or DEXTENZA360 Case Manager.

DEXTENZA360 provides comprehensive support for obtaining benefits verification and determining the appropriate codes preferred by the payer. Medicare Part B with a supplement is typically predictable regarding coverage and payment. For Medicare Advantage (Part C) or commercial patients, we recommend contacting your Ocular Therapeutix Field Reimbursement Manager or DEXTENZA360 beforehand.

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IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

DEXTENZA is contraindicated in patients with active corneal, conjunctival or canalicular infections, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella; mycobacterial infections; fungal diseases of the eye, and dacryocystitis.

WARNINGS AND PRECAUTIONS

Intraocular Pressure Increase – Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. Steroids should be used with caution in the presence of glaucoma. Intraocular pressure should be monitored during treatment.

Bacterial Infections – Corticosteroids may suppress the host response and thus increase the hazard for secondary ocular infections. In acute purulent conditions, steroids may mask infection and enhance existing infection.

Viral Infections – Use of ocular steroids may prolong the course and may exacerbate the severity of many viral infections of the eye (including herpes simplex).

Fungal Infections – Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use. Fungal culture should be taken when appropriate.

Delayed Healing – Use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation.

Other Potential Corticosteroid Complications – The initial prescription and renewal of medication order of DEXTENZA should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy, and, where appropriate, fluorescein staining. If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated.

ADVERSE REACTIONS

Ocular Inflammation and Pain Following Ophthalmic Surgery
The most common ocular adverse reactions that occurred in patients treated with DEXTENZA were: anterior chamber inflammation including iritis and iridocyclitis (10%), intraocular pressure increased (6%), visual acuity reduced (2%), cystoid macular edema (1%), corneal edema (1%), eye pain (1%), and conjunctival hyperemia (1%). The most common non-ocular adverse reaction was headache (1%).

Itching Associated with Allergic Conjunctivitis
The most common ocular adverse reactions that occurred in patients treated with DEXTENZA were: intraocular pressure increased (3%), lacrimation increased (1%), eye discharge (1%), and visual acuity reduced (1%). The most common non-ocular adverse reaction was headache (1%).

INDICATIONS

DEXTENZA is a corticosteroid indicated for:

  • The treatment of ocular inflammation and pain following
    ophthalmic surgery.
  • The treatment of ocular itching associated with allergic
    conjunctivitis.