DAXXIFY

Indicated For

cervical dystonia

About This Medication

# DAXXIFY® Patient Assistance Program Patient Guide: How to Get DAXXIFY (daxibotulinumtoxinA-lanm) at Low or No Cost DAXXIFY® (daxibotulinumtoxinA-lanm) Patient Assistance Program offers free medication to **uninsured patients** facing financial hardship, administered by **Revance Therapeutics, Inc.** This guide explains eligibility, application steps, and support options for accessing this botulinum toxin treatment for **cervical dystonia** or **glabellar lines**.[4][5] ## About DAXXIFY® **DAXXIFY®** is an FDA-approved injection containing **daxibotulinumtoxinA-lanm**, a purified botulinum toxin type A powered by a novel peptide formulation. It temporarily improves **moderate to severe frown lines** (glabellar lines) in adults by relaxing corrugator and procerus muscles, with results starting in as little as **2 days** and lasting up to **6 months** for over 50% of patients. It's also approved for **cervical dystonia** in adults, providing long-lasting relief from neck muscle spasms using specific CPT codes like 64616 for administration.[1][4][5][8] Clinical data shows **74%** of patients achieved ≥2-grade improvement at week 4, per physician and patient assessments. Unlike other neurotoxins, its peptide technology creates a strong bond for efficient delivery and prolonged effect. Common uses include aesthetic frown line reduction and therapeutic cervical dystonia management, but it's **not for spasticity** or other unapproved conditions. Always consult your doctor for suitability, as effects may spread, causing symptoms like respiratory issues—seek immediate help if needed.[5][6] **Important Safety Notes**: Not interchangeable with other botulinum toxins. Avoid in pregnancy, children, or with certain neuromuscular disorders. Full prescribing info is available via your provider.[5] ## Who Qualifies? This program targets **uninsured patients** experiencing financial need. No specific **income thresholds** (e.g., FPL percentages) are publicly detailed, suggesting case-by-case review based on hardship. It's explicitly for those **without insurance coverage** for DAXXIFY®, distinguishing it from savings cards or rebates for insured cosmetic users.[4][1][2] Eligible patients typically have a valid prescription for DAXXIFY® from a U.S. healthcare provider for approved indications. Contact a **reimbursement and access manager** via the HCP site to start—ideal for practices supporting cervical dystonia patients.[4] ## Income Eligibility Breakdown Limited public details exist on exact income limits, as the program evaluates **uninsured status** and financial hardship individually. No fixed FPL percentage or household size thresholds are specified. | Household Size | Income Threshold | Notes | |---|---|---| | Individual | Not specified | Case-by-case for uninsured | | Couple | Not specified | Financial hardship assessed | | Family of 3 | Not specified | Uninsured patients only | | Family of 4+ | Not specified | Provider coordination required | **Key**: Focus on lack of insurance; provide proof of income/hardship during enrollment. Programs like this often align with 400-500% FPL but confirm via Revance.[4] ## Insurance Requirements **Uninsured patients only**—no Medicare, Medicaid, commercial insurance, or government coverage accepted. If insured, explore **Radiant Rewards Rebate** or savings programs instead (e.g., $50 off cosmetic treatments, valid through March 31, 2026).[1][3][4] ## Step-by-Step Application Process 1. **Consult Your Doctor**: Get a DAXXIFY® prescription for cervical dystonia or glabellar lines. Discuss administration codes (e.g., CPT 64616, JZ modifier for no waste).[4] 2. **Verify Eligibility**: Confirm uninsured status. Visit the HCP access page (hcp.daxxifycervicaldystonia.com/access-daxxify) and complete the form—a **reimbursement and access manager** will contact you.[4] 3. **Gather Documents**: Prepare proof of no insurance, prescription, income details (e.g., tax returns, pay stubs), and ID. Exact list confirmed by manager.[4] 4. **Submit Application**: Multiple methods likely (online form, phone, fax)—manager guides you post-inquiry. No direct patient phone/URL listed; provider-led.[4] 5. **Approval Wait**: Timeline varies; manager coordinates billing/coding for reimbursement.[4] 6. **Receive Treatment**: Medication shipped to provider's office for injection. Patient pays nothing if approved.[4] ## Timeline and Delivery **Processing time** not specified—expect weeks after submission, depending on documentation. Delivery to **provider's office** only (physician-administered). Follow-up with manager for status. Cosmetic rebates process post-treatment via code redemption.[3][4] ## Alternatives if Denied - **Savings Programs**: For insured/cosmetic use, get rebate codes via daxxify.com or provider QR scan (e.g., $50 off, submit proof by March 31, 2026).[1][3] - **Other PAPs**: Check NeedyMeds, RxAssist for botulinum alternatives. - **Generic/Competitors**: No biosimilars listed; consider other botulinum toxins via their PAPs (e.g., Botox Savings). - **Provider Assistance**: Practices may offer samples or payment plans.[4][7] ## Disclaimer This guide is for informational purposes based on available data as of 2026. Eligibility/terms may change—**contact Revance directly** via provider portal for latest details. Not medical advice; consult your healthcare provider. Revance not liable for application outcomes. Report side effects to 1-877-373-8669 or FDA.[4][5]

Program information last verified: March 30, 2026