Patient Support for those prescribed Dysport®.

Once the doctor has prescribed Dysport® (abobotulinumtoxinA) for injection, the Patient Access Specialists at IPSEN CAREScan help provide applicable patient coverage information, as appropriate, between the patient, doctor’s office, insurance company, and specialty pharmacy. By serving as a central point of contact, IPSEN CARES can help patients with questions about access to our medications and provide support throughout the process.

Step 1
Enroll

Patients must enroll in Ipsen Cares through the doctor's office to verify benefits.

Our Patient Access Specialists will check each patient’s pharmacy and medical benefits to determine if the drug is covered for the indication the treating physician has specified. If there are any restrictions, IPSEN CARES will provide the information required by the insurance company that the doctor may need to complete. A summary of all the information collected will be sent back to the doctor’s office in a single document called Benefit Verification Results. Benefit verifications are usually turned around within 4 business hours upon receipt of the completed enrollment form and patient authorization.

Health care providers (HCPs) can help patients enroll in three ways:

  1. Through our online provider portal
  2. By printing a downloadable PDF to be filled out and faxed
  3. By calling the Patient Access Specialists at IPSEN CARESat (866) 435-5677

Patients and Health Care Providers can also call IPSEN CARES at (866) 435-5677

Step 2
Authorize

Patients/Caregivers are required to sign the Dysport® Patient Authorization form every 12 months to give the Patient Access Specialists at IPSEN CARES permission to access their personal health information in order to help with treatment. The form can be signed and submitted online, or by downloadable PDF, which must be printed, filled out, signed, and faxed.

Patients/Caregivers, Sign and Submit
Online Patient Authorization Form
Or Download and Print
Patient Authorization Form
Step 3
Help with Copays?

Check for copay coverage. Considering that some patients need financial assistance, our copay assistance programs may help eligible* patients with their treatment.

The Dysport® Copay Assistance Program for eligible, commercially insured patients is available by enrolling in IPSEN CARES. Here is the key information:

  • Each eligible patient will have a portion of their out-of-pocket costs covered for up to 4 treatments or for 1 year from their enrollment date, whichever comes first
  • Savings up to $1,500 off the cost of the first treatment, and $750 off the cost of the second, third, and fourth treatments each, for an annual maximum of $3,750
  • If eligible, patients will have virtual payments paid directly to their HCP offices or hospitals to cover out-of-pocket cost
  • Patients and/or HCP offices should send IPSEN CARES the Explanation of Benefits to initiate the delivery of virtual payments

Patients may self-enroll in the copay program by utilizing the form below and completing the Patient Authorization form, or by calling 866-435-5677 to speak with an IPSEN CARES Patient Access Specialist, Monday-Friday, from 8:00 AM to 8:00 PM ET (5:00 AM to 5:00 PM PT).

Patient/Caregivers, Download and Print

For patients who have government insurance (eg, Medicare, Medicaid, TRICARE) IPSEN CARES may be able to offer the contact information for independent nonprofit foundations that offer financial assistance.

Below Are More Ways We Can Provide Assistance

C.L.I.M.B.® Injection Training (Continuum of Learning to Improve Management with Botulinum Toxin)

C.L.I.M.B.® is a multitiered learning continuum designed to accommodate physicians with every level of experience with botulinum toxin therapy. C.L.I.M.B.® will help physicians across all levels improve their clinical skills involving the appropriate use of Dysport®  through hands-on injection training, online activities, and educational materials.

To learn more, visit climb-training.com.

Free Medication

Uninsured patients may be eligible* for free medication through our Patient Assistance Program. To qualify, patients must be: 1) uninsured, 2) US residents, and 3) meet certain income criteria. Patients may enroll through IPSEN CARES. If eligible, they will receive free medication from Ipsen.

Or Patients/Caregivers  
Patient Assistance Program Form
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*Patient Eligibility & Terms and Conditions: Patients who are eligible to participate (i.e. prescriptions or coverage could be paid in part or in full) in any state or federally funded programs, including, but not limited to, Medicare or Medicaid, VA, DOD, or TRICARE (collectively, “Government Programs”) are not eligible for copay assistance through IPSEN CARES. Patients residing in Massachusetts, Minnesota, Michigan, or Rhode Island can only receive assistance with the cost of Ipsen products but not the cost of related medical services (injection). Patients receiving free starter therapy through the IPSEN CARES program are not eligible for the copay assistance program while they are waiting for insurance prescription coverage to begin. Patients receiving assistance through another assistance program or foundation, free trial, or other similar offer or program also are not eligible for the copay assistance program during current enrollment year.Patient or guardian is responsible for reporting receipt of copay savings benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled through the program, as may be required. Additionally, patients may not submit any benefit provided by this program for reimbursement through Flexible Spending Account, Health Savings Account, or Health Reimbursement Account. Ipsen reserves the right to rescind, revoke, or amend these offers without notice at any time. Ipsen and/or TrialCard, Incorporated, are not responsible for any transactions processed under this program where Medicaid, Medicare, or Medigap payment in part or full has been applied. Cash-paying patients are eligible to participate. “Cash-pay” patients are defined for purposes of this program as patients without insurance coverage or who have commercial insurance that does not cover Dysport®.  Medicare Part D enrollees who are in the prescription drug coverage gap (the “donut hole”) are not considered cash-pay patients and are not eligible for the copay benefit. Data related to your participation may be collected, analyzed, and shared with Ipsen for market research and other purposes related to assessing the program. Data shared with Ipsen will be de-identified, meaning it will not identify you. Void outside of the United States and its territories or where prohibited by law, taxed, or restricted. This program is not health insurance. No other purchase is necessary. Offer expires December 31, 2017, however, patients residing in Massachusetts are only eligible to receive assistance through June 30, 2017.Maximum benefit paid by Ipsen Biopharmaceuticals, Inc., will be a maximum of $3,750 in annual savings, 4 treatments, or 1 year from patient’s enrollment date, whichever comes first.  The patient may receive up to $1,500 for the 1st Rx, and then up to $750 for the 2nd, 3rd and 4th Rx in 2017. There could be additional financial responsibility depending on the patient’s insurance plan.

Important Safety Information

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Dysport® (abobotulinumtoxinA) may cause serious side effects that can be life threatening, including problems breathing or swallowing, and spread of toxin effects. These problems can happen within hours, or days to weeks after an injection of Dysport®. Death can happen as a complication if you have severe problems with swallowing or breathing after treatment with Dysport®. Call your doctor or get medical help right away if you have any of these problems after treatment with Dysport®:

  • Problems swallowing, speaking, or breathing after an injection of Dysport® if the muscles that you use to breathe or swallow become weak. If these problems are severe, death can happen as a complication. People with certain breathing problems may need to use muscles in their necks to help them breathe and may be at greater risk for serious breathing problems with Dysport®
  • Swallowing problems may last for several weeks; you may need a feeding tube to receive food or water. If swallowing problems are severe, food or liquids may go into your lungs. People who already have swallowing or breathing problems before receiving Dysport® have the highest risk of getting these problems

Spread of toxin effects. In some cases, the effects of botulinum toxin may affect areas of the body away from the injection site and cause symptoms of a serious condition called botulism. The symptoms of botulism include: loss of strength and muscle weakness all over the body, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, or trouble swallowing. These problems could make it unsafe for you to drive a car, operate machinery, or do other dangerous activities.

Do not take Dysport® if you are allergic to Dysport® or any of the ingredients in Dysport® (See Medication Guide for ingredients), or are allergic to cow’s milk protein; had an allergic reaction to any other botulinum toxin product, such as Myobloc® (rimabotulinumtoxinB), Botox® (onabotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); or have a skin infection at the planned injection site.

Before you take Dysport®, tell your doctor about all your medical conditions, including if you have a disease that affects your muscles and nerves (such as amyotrophic lateral sclerosis [ALS or Lou Gehrig’s disease], myasthenia gravis, or Lambert-Eaton syndrome), as you may be at increased risk of serious side effects, including difficulty swallowing or breathing.

Before you take Dysport®, tell your doctor if you have or have had any of the following: a side effect from any botulinum toxin in the past; breathing problems such as asthma or emphysema; swallowing problems; bleeding problems; diabetes; and slow heartbeat, or other problems with your heart rate or rhythm.

Tell your doctor if you have plans to have surgery, had surgery on your face, have weakness of your forehead muscles (such as trouble raising your eyebrows), have drooping eyelids, or have any other change in the way your face normally looks.

Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding or planning to breast-feed. It is not known if Dysport® can harm your unborn baby. It is not known if Dysport® passes into breast milk.

Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal products. Using Dysport® with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received Dysport® in the past.

Especially tell your doctor if you have received injections of botulinum toxin in the last four months or in the past. Be sure your doctor knows exactly which product you received such as Myobloc® (rimabotulinumtoxinB), Botox® (onabotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; or take a sleep medicine.

Most common side effects of Dysport® in people with upper limb spasticity include: urinary tract infection, muscle weakness, musculoskeletal pain, fall, depression, stuffy or runny nose and sore throat, and dizziness.

Most common side effects of Dysport® in people with cervical dystonia include: muscle weakness, dry mouth, feeling of tiredness, muscle pain, problems speaking, eye problems, difficulty swallowing, injection site pain, and headache.

Most common side effects of Dysport® in children (2 to 17 years of age) with lower limb spasticity include: upper respiratory infection, stuffy or runny nose and sore throat, flu, cough, and fever.

Tell your doctor if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of Dysport®. For more information, ask your doctor or pharmacist.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Click here to view Dysport® Full Prescribing Information including Boxed Warning and Medication Guide.

Botox®, Xeomin®, and Myobloc® are registered trademarks of their respective owners.

Indications

What is Dysport®?

Dysport® is a prescription medicine that is injected into muscles and used to treat:

  • increased muscle stiffness in elbow, wrist, and finger muscles in adults with upper limb spasticity
  • cervical dystonia (CD) in adults
  • increased muscle stiffness in calf muscles in children 2 years of age and older with lower limb spasticity

It is not known whether Dysport® is safe or effective in children under 2 years old for the treatment of lower limb spasticity.

It is not known whether Dysport® is safe or effective for the treatment of other types of muscle spasms.

It is not known whether Dysport® is safe or effective for the treatment cervical dystonia or upper limb spasticity in children under 18 years of age.

Need immediate assistance?Call (866) 435-5677.

Our Patient Access Specialists are available Monday-Friday, from 8:00 AM to 8:00 PM ET (5:00 AM to 5:00 PM PT).

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