The DEXYCU Assurance Program Process

EyePoint Pharmaceuticals will provide a replacement unit 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 replacement unit for DEXYCU for any unit that is denied reimbursement
STEP 1

Verify coverage with the payer

To be eligible for a replacement unit, 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.

  1. Conduct benefits investigation
  2. Results of benefits investigation indicate patient has coverage for DEXYCU
  3. If required by the payer, provider must obtain Prior Authorization, Pre-Certification, or Pre-Determination
  4. Administer purchased unit of DEXYCU to patient
  5. Provider must submit claim per payer billing and coding requirements
STEP 2

Request replacement unit*

  1. 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
  2. Receive a replacement unit of DEXYCU

*Eligibility for the replacement unit described herein is limited to 120 days from date of service (i.e., administration date). Claims must be received by September 30, 2020.

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