SAVE on YOUR XIAFLEX® COPAY
Most eligible patients with commercial insurance plans paid $0 copay through the XIAFLEX® Copay Assistance Program.*
How much you pay for XIAFLEX® will depend on your health benefits or insurance coverage. The XIAFLEX® Copay Assistance Program can cover up to $1200 of your out-of-pocket costs for each injection.
|Scenario 1||Scenario 2||Scenario 3
(for 2 vials)
|If your out-of-pocket cost for XIAFLEX® is||$100||$1200||$2650|
|For eligible patients, the XIAFLEX® Copay Assistance Program pays||$100||$1200||$2400||You pay||$0||$0||$250|
*Based on analysis of claims filed September 2011 through March 2018.
Questions about additional financial assistance? Call 877-XIAFLEX (877-942-3539) for more information.
How to use the XIAFLEX® Copay Assistance Program
There are two ways to register for the XIAFLEX® Copay Assistance Program. It just depends on how your doctor orders the treatment.
- If your doctor orders XIAFLEX® directly:
- Complete the Reimbursement Form and tell your doctor that you’d like to participate in the program
- If you are eligible, your doctor’s office will be able to help you access program assistance
- Your doctor will let you know how much, if anything, you owe
- If your doctor tells you he or she orders XIAFLEX® from US Bioservices Specialty Pharmacy:
- US Bioservices may contact you at home for more information and to discuss your copay
- If you miss the call, it is important you return US Bioservices’ call as soon as possible to help fill your prescription properly
- 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
- If you have not heard from them within 7 days, feel free to call them at 1-855-534-8323
- Once benefits have been determined, US Bioservices will let you know how much, if anything, you owe
After confirming your shipment, contact your doctor's office to schedule your injection of XIAFLEX®.
For more information about Specialty Pharmacies, please download the Specialty Pharmacy Information Card.
Before enrolling in the XIAFLEX® Copay Assistance Program, it’s important to identify if you are eligible. The information below may help you determine that. You can also call 877-XIAFLEX (877-942-3539) for more assistance.
XIAFLEX® Copay Assistance Program patient eligibility
You may qualify for assistance. Review the checklist to see if you’re a candidate.
- You are receiving or received XIAFLEX® for an approved indication and in a manner consistent with the instructions for administration of XIAFLEX®
- You are uninsured or have insurance that is not provided by Medicare, Medicare Prescription Drug Benefit plans, Medicare Advantage, Veterans Affairs (VA), Medicaid, or similar federal or state programs and the offer is not otherwise prohibited by law
- You are 18 years of age or older
- You have paid or are obligated to pay out-of-pocket costs for a dose of XIAFLEX®
- You have not used this program within the last 30 days
Restrictions, Terms, and Conditions
- 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.
- 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.
- 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.
- This offer is only valid for doses of XIAFLEX® administered in the United States.
- 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®.
- This offer is valid only if you have not used this program within the last 30 days.
- The selling, purchasing, trading, or counterfeiting of this offer is prohibited.
- 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.
- 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.
ADDITIONAL FINANCIAL ASSISTANCE PROGRAMS
If you are not eligible for Copay Assistance, there may be other programs that could help you pay for your prescription.
To find out about additional financial assistance, call 877-XIAFLEX (877-942-3539).
No other purchase is necessary to receive this offer.