Financial Assistance
Dysport Copay Assistance Program
If you have been prescribed Dysport and you have commercial (private) insurance, you may be eligible* to receive copay assistance and pay as little as $0 per prescription for Dysport.
YOU MAY BE ELIGIBLE* IF YOU…
- Have commercial (private) health insurance that covers Dysport
- Have no primary or secondary insurance coverage under any state or federal healthcare program (like Medicare or Medicaid)
- Are a resident of the US
- Have a valid prescription for Dysport
Copay Claims Reimbursement
If you are enrolled in copay assistance, you can submit reimbursement claims by uploading required documents here:
Download the Dysport Member Reimbursement Form for more information.
Dysport Patient Assistance Program
This program is for patients who are experiencing financial hardship and who meet certain financial eligibility† requirements.
YOU MAY BE ABLE TO RECEIVE FREE MEDICATION THROUGH OUR PATIENT ASSISTANCE PROGRAM IF YOU…
- Are enrolled in IPSEN CARES‡
- Are uninsured or if your insurance does not cover Dysport
- Are a resident of the US
- Have a valid prescription for on-label use of Dysport as supported by information provided in the program application
- Meet program financial eligibility† requirements
You must be enrolled in IPSEN CARES to be approved for the Patient Assistance Program. Please speak with your doctor if you are not enrolled.
Eligibility† does not guarantee approval for participation in the Patient Assistance Program. Please talk with your doctor about enrolling in IPSEN CARES.
Please see Medication Guide and full Prescribing Information for Dysport, including BOXED WARNING.
