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

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 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, 2018. 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.

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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Important Safety Information

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What is the most important information I should know about Dysport?

Dysport may cause serious side effects, including problems breathing or swallowing and/or spread of toxin effects, that can be life threatening and death can happen as a complication. These problems can happen within hours, or days to weeks after an injection of Dysport.

  • Problems swallowing, speaking, or breathing Treatment with Dysport can result in swallowing or breathing problems. People with pre-existing swallowing or breathing problems may be at greater risk following treatment 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.
  • Spread of toxin effects. 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 which include: loss of strength and muscle weakness all over the body, double or blurred vision, and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, and trouble breathing or swallowing. The risk of these symptoms is probably greatest in children treated for spasticity. These problems could make it unsafe for you to drive a car, operate machinery, or do other dangerous activities.

Call your doctor or get medical help right away if you experience these problems after treatment with Dysport.

Do not receive a Dysport injection if: you are allergic to Dysport or any of its ingredients, or cow’s milk protein; you had an allergic reaction to any other botulinum toxin product, such as Myobloc®, Botox®, Xeomin®; or you have a skin infection at the planned injection site.

Before you receive a Dysport injection tell your doctor:

  • About all your medical conditions, including if you have a disease that affects your muscles and nerves (such as ALS or Lou Gehrig’s disease [amyotrophic lateral sclerosis], myasthenia gravis, or Lambert-Eaton syndrome). You may be at increased risk of serious side effects, including difficulty swallowing or breathing.
  • If you have plans to have surgery, had surgery on your face, have weakness of your forehead muscles (trouble raising your eyebrows), drooping eyelids, or any other change in the way your face normally looks.
  • If you are pregnant or breastfeeding or plan to become pregnant or breastfeed. It is not known if Dysport can harm your unborn baby or if it passes into breast milk.
  • About all the medicines you take, including prescription and over-the-counter 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 any other injections of botulinum toxin in the last four months or ever; Myobloc®, Botox®, or Xeomin® (exactly which ones); an antibiotic recently by injection; or if you take muscle relaxants; allergy, cold or sleep medicine.

Most Common Side effects of Dysport in:

  • adults with upper limb spasticity include: urinary tract infection, muscle weakness, musculoskeletal pain, fall, depression, stuffy or runny nose and sore throat, and dizziness.
  • adults with lower limb spasticity include: muscle weakness, pain in your arms or legs, and fall.
  • 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.
  • 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 may report side effects to the FDA at www.fda.gov/medwatch or call 1-800-FDA-1088.

Indication

What is Dysport?

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

  • cervical dystonia (CD) in adults
  • increased muscle stiffness in adults with spasticity
  • increased muscle stiffness 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; for treating other types of muscle spasms; or for treating cervical dystonia or upper limb spasticity in children under 18 years of age.

Please see Full Prescribing Information including Boxed Warning and Medication Guide

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

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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