Are you or a loved one living with keratoconus and currently considering your potential treatment options? If your doctor has recommended FDA-approved corneal cross-linking— the first and only FDA-approved therapeutic treatment that stiffens the cornea to slow or halt the progression of keratoconus, then you may now be eligible to receive up to $100 towards your non-reimbursable copay expenses through our new patient support program.
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If you are eligible, the Living with Keratoconus Patient Support Program can help offset some of your out of pocket costs for the FDA-approved epi-off corneal cross-linking procedure with the Photrexa® drug formulations [Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa® (riboflavin 5’-phosphate ophthalmic solution)]. You can receive a voucher for up to $100 towards your non-reimbursable copay expenses.
This program is available to anyone with commercial insurance coverage and will accept submissions for procedures completed between June 15, 2020, and December 31, 2020. Voucher requests must be submitted by February 28, 2021.
As mentioned, this program is open to anyone with commercial insurance coverage. However, it is important to note that those who are a government beneficiary and/or participant in a federal or state-funded health insurance program (ex: Medicare, Medicare Advantage, Medigap, Medicaid, VA, DoD, TRICARE) are not eligible, as mandated by government guidelines. This is typical for all copay programs like this and is not unique to our program.
If you’re unsure whether or not your insurance plan covers FDA-approved cross-linking, visit our website to see if your plan is on the list.
Enrolling in the Patient Support Program is easy and requires only a few steps:
- Fill in the form to enroll in the Living with Keratoconus Patient Support Program. From there, you will receive a voucher code.
- Make an appointment with your doctor performing the FDA-approved corneal cross-linking, or locate a doctor near you by using our physician locator tool.
- If your doctor determines you need the FDA-approved corneal cross-linking procedure, schedule your procedure to be completed before the program end date of December 31, 2020.
- After you have the procedure, submit your Voucher Request with the Explanation of Benefits for your corneal cross-linking procedure with the Photrexa drug formulations from your commercial insurance provider.
Frequently Asked Questions
We know insurance coverage can be tricky, and you may have questions about this new program, so we’re here to help! Below are some answers to frequently asked questions about the Living with KC Patient Support Program.
What expenses does the voucher program cover?
The Program will cover certain non-reimbursable out of pocket copay expenses for the FDA-approved cross-linking procedure with Photrexa drug formulations up to $100. The maximum payment under the program is $100. The Explanation of Benefits form you receive from your commercial insurance provider should show both the professional fee and pharmaceutical fee associated with your procedure. Legally, the copay voucher can only apply to your out of pocket expenses related to the pharmaceutical fee.
Your Explanation of Benefits Form should show:
- J2787 – This is the J code for the Photrexa drug formulations. Your copay related to this code will be eligible for reimbursement.
- 0402T – This T code is related to your physician’s time during the procedure and is not eligible for reimbursement as part of this program.
Does my doctor have to do anything to participate in the program?
No, your doctor’s office will process your claim with your insurance provider as usual. Your insurance provider will provide you with the Explanation of Benefits documentation which is required to submit your voucher.
How does a patient get paid?
Once your voucher has been submitted via our online portal and approved, you will receive a prepaid bank card in the mail to the mailing address you provide.
How long does the payment take to process?
Once your voucher has been submitted, it will typically take up to four weeks for you to receive a prepaid debit card in the mail. For example, if you submitted your voucher request on September 1, 2020, you should expect to receive your voucher payment by September 30, 2020.
Where can I find a doctor who offers FDA-approved cross-linking?
You can find a list of doctors who perform FDA-approved cross-linking with Photrexa drug formulations on our physician locator.
To see additional questions about the program, visit our website to see the full list.
We’re here to support you throughout your keratoconus journey. If you or a loved one are living with keratoconus, don’t hesitate to make an appointment with your eye doctor to learn more about your available FDA-approved treatment options or to schedule your cross-linking procedure. If you are eligible and you are planning to receive this treatment before December 31, 2020, enroll in our Patient Support Program today to receive up to $100 towards your copay.