Eligible candidates get up to $100 towards their non-reimbursable copay expenses.

Are you living with Keratoconus?

You may be a candidate for the FDA approved corneal cross-linking procedure with Photrexa® drug formulations [Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa® (riboflavin 5’-phosphate ophthalmic solution)] and the KXL® System that slows or halts the progression of keratoconus.

Receive up to $100* towards your non-reimbursable copay expenses.

Enroll in the Living with Keratoconus Patient Support Program

Eligibility

This program is open to anyone with commercial insurance coverage. As is typical of co-pay programs, those who are a government beneficiary and/or participant in a federal or state-funded health insurance program (eg, Medicare, Medicare Advantage, Medigap, Medicaid, VA, DoD, TRICARE) are not eligible, as mandated by government guidelines.

Enrollment

Take the following steps to enroll in the program:

  • Fill in the form to enroll in the Living With Keratoconus Patient Support Program.   You will receive a voucher code.   
  • Make an appointment with your doctor performing the FDA approved corneal collagen cross-linking procedure with Photrexa® drug formulations and the KXL® System or locate a doctor near you by using the LivingwithKC.com doctor locator. 
  • If your doctor determines you need the corneal cross-linking procedure with Photrexa® drug formulations, the Living With Keratoconus Patient Support Program will cover your non-reimbursable out of pocket copay expenses up to $100*.
  • The Living With Keratoconus Patient Support program will accept submissions for procedures completed between June 15, 2020 and September 30, 2020.   
  • Submit a Voucher Request with the Explanation of Benefits from your commercial insurance provider related to the corneal cross-linking procedure with Photrexa® drug formulations after you have the procedure. Voucher requests for procedures completed between June 15, 2020, and September 30, 2020, must be submitted by November 15, 2020.  
  • All successful voucher applications will receive reimbursement in the form of a check to the mailing address provided.

Check Out Our FAQs for More Information Download PDF

The Living With Keratoconus Patient Support Program (The Program) is sponsored by Glaukos. Glaukos’s mission is to transform the treatment of chronic eye diseases with novel therapies that provide sustainable solutions to important clinical needs.

LivingwithKeratoconus.com is an inclusive patient community that supports you on your keratoconus journey.

*The Living With Keratoconus Patient Support Program covers copays related to the performance of the FDA approved corneal cross-linking procedure with Photrexa® drug formulations up to $100. The maximum payment under the program is $100.

The program runs from June 15, 2020 and September 30, 2020. Offer is valid only in the United States and U.S. Territories. Voucher requests for procedures completed between June 15, 2020, and September 30, 2020, must be submitted by November 15, 2020. The patient must have enrolled in the Living With Keratoconus Patient Support Program and have received a voucher code to request a payment under the program. The patient or their guardian must be 18 years or older for the patient to be eligible. This Program is only valid in the United States and U.S. Territories. This Program is void where prohibited by law. This offer cannot be combined with other offers. Not valid for copays that are not related to the FDA approved corneal cross-linking procedure with Photrexa® drug formulations [Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa® (riboflavin 5’-phosphate ophthalmic solution)] and the KXL® System that slows or halts the progression of keratoconus. Receipts must clearly state that the copays were for the corneal cross-linking procedure with Photrexa® drug formulations.

The Explanation of Benefits (EOB) Form you receive from your 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 EOB form should show J2787 and 0402T. The J code is for the Photrexa drug formulations. Your copay related to this code will be eligible for reimbursement. The T code is related to your physician’s time during the procedure and is not eligible for reimbursement as part of this program.

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