Leave reimbursement risk behind with the EyePoint AssistSM Assurance Program*

Coverage you can count on

In 2019 DEXYCU was granted pass-through status, ensuring coverage for all Medicare Part B patients.

But what about patients who have Medicare Advantage or commercial Plans?

The Assurance Program is designed to help Ambulatory Surgery Centers (ASCs) evaluate the payer landscape to determine how much regional Medicare Advantage and commercial payers will reimburse for DEXYCU. With the Assurance Program, you can feel confident that if you submit a claim to a Medicare Advantage or commercial plan and the claim is denied or underpaid, EyePoint will directly reimburse your ASC the difference between the underpaid or denied amount and the acquisition cost, subject to terms and conditions. Simply put, the Assurance Program minimizes reimbursement risk to help our ASC partners simplify their workflow and implement a single postoperative inflammation protocol.

If you are denied or underpaid reimbursement, EyePoint Pharmaceuticals will:

  • Reimburse the difference between the acquisition cost and the amount paid by commercial payers
  • Reimburse the full acquisition cost for patients with Medicare Advantage
  • Difference is paid directly to the ASC within 45 days of the Assurance claim being approved

See the Assurance Program at work

Commercial insurance

In this example, the DEXYCU acquisition cost is $595. After submitting a claim to commercial insurance plan A, the ASC only receives $400 in reimbursement—$380 from the insurance plan and $20 from the patient. To ensure the ASC doesn’t lose money, EyePoint will cover the difference and pay the ASC $195 within 45 days if the Assurance claim is approved.

Medicare Advantage

In this example, the DEXYCU acquisition cost is $595, and after submitting the claim to Medicare Advantage plan C, the ASC receives notice that the claim is denied. The ASC is at risk of losing $595 or the total acquisition cost. If the assurance claim is approved, EyePoint Assist will pay the ASC the full acquisition cost, $595, within 45 days to ensure the ASC does not assume financial liability.

Regardless of insurance, DEXYCU is an option for nearly all patients

Medicare Part B patients are covered, and claims will be reimbursed. For all other patients, ASCs can use the Assurance program to determine who will be covered.

*Subject to program terms and conditions, ASCs will be reimbursed the full acquisition cost for patients with Medicare Advantage and will receive the difference between the acquisition cost and the amount paid for patients with commercial insurance. After a claim is denied by a payer, ASCs should adjust their reimbursement strategy to minimize reimbursement risk associated with that payer.

Call 1-833-EYEPOINT today (1-833-393-7646), option 3. We are available Monday through Friday, 8:30 AM–8:00 PM ET.