The DEXYCU Assurance Program Process
EyePoint Pharmaceuticals will provide a discount on future orders for any unit of DEXYCU that is denied reimbursement through Commercial or Medicare Advantage coverage when all program requirements are met.*
- When provider follows all required steps for qualifying patients, provider will receive a 16.6% discount off the next 6 orders of DEXYCU
Verify coverage with the payer
To be eligible for a discount on future orders, provider must follow all requirements identified by the benefits investigation. Only patients under Commercial or Medicare Advantage are eligible. The program is not valid for patients who are covered under Medicaid or Medicare.
- Conduct benefits investigation
- Results of benefits investigation indicate patient has coverage for DEXYCU
- If required by the payer, provider must obtain Prior Authorization, Pre-Certification, or Pre-Determination
- Administer purchased unit of DEXYCU to patient
- Provider must submit claim per payer billing and coding requirements
- If the provider denies initial claim, complete the DEXYCU Assurance Program Request Form and fax it with the required documentation to the number on the form‡
- Receive a 16.6% discount off the next 6 orders of DEXYCU
*Discount of 16.6% off next 6 orders cannot be combined with additional rebate programs.
†Eligibility for the 6-unit discount described herein is limited to 120 days from date of service (i.e., administration date). Claims must be received by June 30, 2020.
‡An authorization number will be issued upon approval; no paperwork will be provided during this step.