The DEXYCU Assurance Program Process
EyePoint Pharmaceuticals will provide a trade credit 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 trade credit
Verify coverage with the payer
To be eligible for trade credit, 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 payer denies Prior Authorization OR the initial claim, provider must complete a first-level appeal
Request trade credit*
- If your first-level appeal is denied, complete the DEXYCU Assurance Program Request Form and fax it with the required documentation to the number on the form†
- Receive a trade credit
*Eligibility for trade credit is limited to 120 days from date of service (i.e., administration date).
†An authorization number will be issued upon approval; no paperwork will be provided during this step.