XIAFLEX® Copay Program Information
SAVE ON YOUR XIAFLEX® COPAY
Most eligible patients with commercial insurance plans paid $0 Copay through the XIAFLEX® Copay Assistance Program.
- With the XIAFLEX® Copay Assistance Program, most eligible patients with commercial insurance plans paid $0 copay for XIAFLEX®*
- The XIAFLEX® Copay Assistance Program can cover up to $1200 of your out-of-pocket costs for each injection of XIAFLEX®
How much you pay for XIAFLEX® will depend on your health benefits or insurance coverage.
*Based on analysis of claims filed September 2011 through November 2016.
Restrictions, Terms, and Conditions
- 1. By accepting this offer, you agree to report the value received under this offer to any health insurer or other third party paying for any part of your XIAFLEX® prescription if you are required to do so by benefit terms, contract, or law.
- 2. This offer is not valid for prescriptions reimbursed in whole or in part by Medicare, Medicare Prescription Drug Benefit plans, Medicare Advantage, VA, Medicaid, or similar federal or state programs, or where otherwise prohibited by law.
- 3. By accepting this offer, you agree that Endo Pharmaceuticals or those working on its behalf may contact your HCP to verify information about treatment that is relevant to verifying your eligibility for this offer.
- 4. This offer is only valid for doses of XIAFLEX® administered in the US.
- 5. This offer is valid for the out-of-pocket cost for the dose of XIAFLEX® only. Offer is not valid for any other products or other out-of-pocket costs (for example, office visit charges, office visit copays, or injection/administration costs) even if those costs are associated with the administration of a dose of XIAFLEX®.
- 6. This offer is valid only if you have not used this program within the last 30 days.
- 7. The selling, purchasing, trading, or counterfeiting of this offer is prohibited.
- 8. Endo Pharmaceuticals reserves the right to rescind, revoke, or amend this offer without notice. You will have up to 365 days after receipt of your Explanation of Benefits (EOB) to submit this offer for processing.
- 9. By participating you understand and agree to comply with the terms and conditions of this offer as set forth above.
Please keep your copay card. You will need to provide information on it to the Specialty Pharmacy if your prescription for XIAFLEX® is processed through them.
How to use the XIAFLEX® Copay Assistance Program
1) Complete the Reimbursement Form and tell your HCP you’d like to participate in the program
- If eligible, your HCP’s office will be able to help you access program assistance
- Once benefits have been determined, your HCP will let you know how much, if anything, you owe
2) If your HCP informs you that he or she orders XIAFLEX® from US Bioservices Specialty Pharmacy
- US Bioservices may contact you at home for additional information
- Current patient privacy laws (HIPAA) prevent US Bioservices from leaving a message about why they are calling. They also may not identify themselves in a phone message
- It is important you return US Bioservices’ call as soon as possible - please call them at
1-855-534-8323if you do not hear from them within 7 days
- Once benefits have been determined, US Bioservices will let you know how much, if anything, you owe
- After confirming your shipment, contact your HCP’s office to schedule your injection of XIAFLEX®
For more information about Specialty Pharmacies, please download the Specialty Pharmacy Information Card.
How much can you save?
The XIAFLEX® Copay Program for eligible patients can cover up to $1200 for each vial of XIAFLEX®.
If your out-of-pocket cost for XIAFLEX® is
For eligible patients, the
ADDITIONAL FINANCIAL ASSISTANCE PROGRAMS
The XIAFLEX® Copay Program is not the only way to get help with paying for your prescription.
To find out about additional financial assistance, call 877-XIAFLEX.