The DEXYCU Assurance Program Process

Follow these convenient and simple steps to assurance

When all program requirements are met, EyePoint Pharmaceuticals will reimburse the difference between your acquisition cost and the amount covered by your plan if you are denied full reimbursement through commercial coverage. If you are denied reimbursement through Medicare Advantage, EyePoint will reimburse your acquisition cost.*
STEP 1

Verify coverage with the payer

To be eligible for acquisition cost reimbursement, service provider must obtain authorization for the procedure. Only patients covered under commercial or Medicare Advantage are eligible. The program is not valid for patients who are covered under Medicaid or Medicare.
STEP 2

Request acquisition cost reimbursement

If the payer denies initial claim, complete the DEXYCU Assurance Program Request Form and fax it with the required documentation to the number on the form.§

EyePoint Pharmaceuticals reserves the right to change or terminate any of the DEXYCU Assurance Program services at any time without notice.

*Facility acquisition cost is determined after application of any discount.

Service provider must submit claim per payer billing and coding requirements.

Claims must be submitted within 1 year of date of surgery. Claims must be received by March 31, 2022.

§An authorization number will be issued upon approval; no paperwork will be provided during this step.