Patient Support for those prescribed Dysport®.

Once the doctor has prescribed Dysport® (abobotulinumtoxinA) for injection, the Patient Access Specialists at IPSEN CARES® can 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.

Program Enrollment

Patients must be enrolled to access all IPSEN CARES® support offerings.

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 CARES® at (866) 435-5677
HCPs, Log In to Submit 
Online Patient Enrollment Form
Or Patients/Caregivers & HCPs,Download and Print
Patient Enrollment Form

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

Patient Authorization

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
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
  • Eligible patient can now save up to an annual maximum benefit of $5,000
  • For patients utilizing the Medical Benefit, we will send details for the Electronic Medical Claims (EMC) processing information on behalf of the patient directly to the doctor's office

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).

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.

*Patient Eligibility & Terms and Conditions: Patients are not eligible for copay assistance through IPSEN CARES® if they are enrolled in any state or federally funded programs for which drug prescriptions or coverage could be paid in part or in full, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE (collectively, “Government Programs”), or where prohibited by law. 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 the current enrollment year.Cash-pay 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 copay assistance through IPSEN CARES®. In any calendar year commencing January 1, the maximum copay benefit amount paid by Ipsen Biopharmaceuticals, Inc. will be $5,000, covering no more than four (4) Dysport® treatments. For cash-pay patients, the maximum copay benefit amount per eligible Dysport® treatment is $1,250, subject to the annual maximum of $5,000 in total. There could be additional financial responsibility depending on the patient’s insurance plan.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 a 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 RxCrossroads by McKesson are not responsible for any transactions processed under this program where Medicaid, Medicare, or Medigap payment in part or full has been applied. Data related to patient 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 the patient. 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, 2019. In any calendar year commencing January 1, the maximum copay benefit paid by Ipsen Biopharmaceuticals, Inc. will be $5,000, covering no more than four (4) Dysport® treatments. For cash-pay patients, the maximum copay benefit amount per eligible Dysport® treatment is $1,250, subject to the annual maximum of $5,000 in total. There could be additional financial responsibility depending on the patient’s insurance plan.Data on file, IPSEN CARES Statistics – 1/2014-12/2018. Basking Ridge, NJ: Ipsen Biopharmaceuticals, Inc; 2018.

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: 1) be uninsured, 2) be US residents, and 3) meet income criteria. Parents/caregivers may enroll their child through IPSEN CARES®. If eligible, they may receive free medication from Ipsen.

Or Patient/Caregivers,Download and Print
Patient Assistance Program Application
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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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