Contact info
- Phone
- 1-800-339-8369
- Fax
- 1-855-518-7564
Eligibility
- Program helps the uninsured, government insured, and commercially insured patients with no payer coverage for DEXTENZA.
- Patients with Medicare Part D may be eligible, contact program for details.
- Income limit, single
- 500% of the federal poverty level
- Income limit, couple
- 500% of the federal poverty level
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Yes
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Not published
- Prescriber license number
- NPI number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Not published
- Shipped to
- Provider
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published
Medications covered
- Dextenza (dexamethasone ophthalmic insert)