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Terms & Conditions

Epioxa Copay Assistance Program Terms and Conditions:

  • Patient eligibility requires enrollment in EpioxaCareConnect™ (ECC) and completion of a benefits investigation.
  • The Epioxa Copay Program (“Program”) is available exclusively to patients with commercial (private or non-governmental) insurance who have a valid prescription for an FDA-approved use of Epioxa.
  • Patients who use Medicare, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD), TRICARE, or any other federal or state government program (collectively, “Government Programs”) to pay for Epioxa or related administration services are not eligible.
  • The Program is also invalid if all costs can be fully reimbursed by commercial insurance or other assistance programs.
  • Under the Program, patients may still be required to pay a co-pay. Depending on individual insurance coverage, out-of-pocket expenses for Epioxa may be reduced to as little as $0 per calendar year. The exact out-of-pocket cost depends on the patient’s health insurance plan.
  • The Program helps cover the cost of Epioxa and, where allowed by law, may also assist with eligible procedure costs directly related to its administration. Program benefits cannot exceed the patient’s actual out-of-pocket expenses for Epioxa. This Program is not health insurance or a benefit plan; the patient’s non-governmental insurance remains the primary payer.
  • Once enrolled, the Program will honor claims for services rendered up to 180 days prior to the enrollment date. Claims must be submitted within 180 days of the date of service, unless otherwise specified.
  • Use of this Program must comply with all relevant health insurance requirements. Patients, pharmacies, physicians’ offices, and hospitals participating in the Program are responsible for reporting all Program benefits received, as required by insurers or the law.
  • Program benefits may not be sold, purchased, traded, or offered for sale.
  • The patient or their guardian must be at least 18 years old to receive assistance through the Program. The Program is valid only in the United States and U.S. Territories and is void where prohibited by law.
  • The Program’s value is intended solely for the benefit of the patient. Funds provided through the Program may only be used to reduce out-of-pocket costs for enrolled patients.
  • Patients must have commercial insurance and provide proof of financial responsibility for a portion of the drug and/or procedure cost, if applicable.
  • This offer cannot be combined with any other rebate, coupon, or similar offer for Epioxa.
  • Glaukos reserves the right at any time to delete, modify, or change the terms, benefits, and conditions without notice.

IMPORTANT SAFETY INFORMATION

The most common side effects were red eye, haze, sensitivity to light, disruption of surface cells of the cornea, eye pain, eye irritation, watery eyes, swelling of eyelid, fine white lines in the cornea, reduced sharpness of vision, dry eye, and eye inflammation.

You should not have the EPIOXA® corneal collagen cross-linking procedure if you have a known hypersensitivity to any ingredients in the product, have had cataract surgery and either did not receive an artificial lens in your eye or received a non-UV blocking artificial lens, have a history of herpetic keratitis, or are pregnant.

If you have any additional questions, please contact your doctor. Please see full Prescribing Information for EPIOXA HD and EPIOXA.

You are encouraged to report all side effects to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. You may also call Glaukos at 1-888-404-1644.

APPROVED USES

The EPIOXA corneal collagen cross-linking procedure is performed by your eye doctor for the treatment of keratoconus. It does not require the removal of the corneal epithelium (outermost layer of the front of the eye). It consists of EPIOXA® HD (riboflavin 5′-phosphate ophthalmic solution) 0.239% and EPIOXA® (riboflavin 5′-phosphate ophthalmic solution) 0.177%, which are prescription eye drops used in combination with the O2n® System and Boost Goggles®.

The EPIOXA corneal collagen cross-linking procedure is for the treatment of keratoconus in adults and pediatric patients 13 years of age and older.