Patient Support

Patients with a financial need have several options to help cover the cost of ILUVIEN® (fluocinolone acetonide intravitreal implant) 0.19 mg

ILUVIEN CoPay Program

Eligible patients who have commercial or private insurance may qualify for assistance with out-of-pocket costs for ILUVIEN. No income eligibility requirement. No maximum assistance level.

No income eligibility requirement. No maximum assistance level.

The ILUVIEN CoPay Program provides assistance toward product-specific copay, co-insurance and insurance deductibles for ILUVIEN that exceed $25. The patient is responsible for a maximum of $25.00 out-of-pocket costs.

Eligibility requirements:

  • Patient must have commercial or private insurance that covers ILUVIEN for the FDA-labeled indication
  • Patient out-of-pocket cost for ILUVIEN must exceed $25
  • Patient must provide household income and number in household
  • Patient must be a resident of the United States

*The program does not cover or provide support for procedures, supplies, or physician-related services associated with ILUVIEN. Only product-specific copay, co-insurance and insurance deductibles are covered. This program is not valid where prohibited by law, taxed or restricted. Alimera Sciences reserves the right to change or cancel this offer or eligibility terms at any time without notice.

ILUVIEN CoPay Program Enrollment Options

Download Patient Enrollment Form

Enter patient’s household income and number in household information on page 2 when enrolling a patient with AccessPlus.

Your office or the patient may
call AccessPlus at
1 844 445 8843, Option 3,
to enroll.

Copay Assistance—Referral to a Foundation

For patients who may need assistance with the out-of-pocket costs for ILUVIEN, AccessPlus can assist with the referral and application process to an independent copay assistance foundation when ILUVIEN is prescribed per the FDA-labeled indication.

Copay assistance foundations are independent organizations. Eligibility criteria are set by the foundation. Alimera Sciences does not control or influence the operations and cannot guarantee assistance will be provided.

Process for referral to a foundation

ILUVIEN Patient Enrollment Form, Page 2

  • Provide patient’s household income and number in household
  • Enter preferred foundation
  • Patient signs and dates “Applicant Authorization” section
  • Fax completed ILUVIEN Patient Enrollment Form to AccessPlus at 1 844 501 7161

AccessPlus completes a benefits investigation for ILUVIEN and determines if a patient out-of-pocket responsibility is expected

If patient is insured by government-funded healthcare and is expected to have financial responsibility for ILUVIEN, AccessPlus will refer to the foundation of your choice. When a decision is made, you will be provided with the application approval status and decision when available

Independent Copay Assistance Foundations with Macular Disease Funds:

Good Days (Chronic Disease Fund)

Phone number
1 877 968 7233

Website
www.mygooddays.org

Hours of operation
Monday-Friday
8 AM-5 PM CST

Patient Access Network (PAN) Foundation

Phone number
1 888 316 7263

Website
www.panfoundation.org

Hours of operation
Monday-Friday
9 AM-5 PM CST

ILUVIEN Patient Assistance Program (PAP)

Provides ILUVIEN free of charge to eligible patients who are uninsured or lack coverage for ILUVIEN.

Eligibility requirements

  • Uninsured or lack coverage for ILUVIEN
  • ILUVIEN must be prescribed per the FDA-labeled indication
  • Patient must be a resident of the United States
  • Patient must have a financial need
  • Based on total adjusted annual household income of $100,000 or less

Process

Fax the completed and signed PAP application to AccessPlus at 1 844 501 7161

The application will be reviewed and an approval decision will be made within 5 business days

The provider office and the patient will receive a letter with the approval status of the application

AccessPlus will coordinate shipment of ILUVIEN to your office upon approval of the patient application

Patient must complete ILUVIEN Patient Assistance Program Application to be considered for the program.