DURYSTA

Indicated For

open-angle glaucoma, ocular hypertension

About This Medication

# DURYSTA Savings Program Patient Guide: How to Get DURYSTA at Low or No Cost ## About DURYSTA DURYSTA (bimatoprost intracameral implant) is a prescription medication used to treat glaucoma and ocular hypertension. Unlike eye drops that require daily application, DURYSTA is a tiny implant placed directly into the eye during a brief in-office procedure. It provides sustained medication delivery to help lower eye pressure and reduce the risk of vision loss from glaucoma. ## Who Qualifies for the DURYSTA Savings Program The DURYSTA Savings Program is designed to help eligible patients afford this treatment. To qualify, you must meet ALL of the following requirements: - Be at least 18 years old - Be a resident of the United States, Puerto Rico, or Guam - Have **commercial insurance coverage** that includes DURYSTA - Not be enrolled in Medicare, Medicaid, or other federal or state healthcare programs - Not be a cash-paying patient - Not have Medicare Advantage coverage combined with employer-sponsored retiree benefits ## Insurance Requirements This program is **only for commercially-insured patients**. Your insurance plan must specifically cover DURYSTA as a medical benefit (not a pharmacy benefit). The program does not apply to patients with: - Medicare coverage - Medicaid coverage - State pharmaceutical assistance programs - Private indemnity or HMO plans that fully reimburse prescription drug costs - Medicare Advantage plans if you're also enrolled in an employer-sponsored retiree health plan If you're unsure whether your commercial plan covers DURYSTA, ask your eye doctor's office to run a benefit verification before your procedure. ## Cost Assistance If you qualify, **eligible patients may pay as little as $0 for each eye**, up to one DURYSTA implant per eye. The exact amount you pay depends on your specific insurance plan's coverage and your out-of-pocket costs. ## How to Enroll Enrolling in the DURYSTA Savings Program is straightforward: 1. **Ask your eye doctor** to enroll you in the program. Your doctor's office handles the enrollment process—you don't need to apply separately. 2. **Provide required information** to your doctor's office, including your insurance details and confirmation that you meet eligibility criteria. 3. **Sign the enrollment form** confirming you understand the program terms and that your information is accurate. 4. **Receive confirmation** from your doctor's office that you're enrolled before your DURYSTA procedure. ## Required Documentation Your doctor's office will need to collect and submit the following documents to process your savings: - Completed DURYSTA Savings Program enrollment form - Your insurance Explanation of Benefits (EOB) for DURYSTA - DURYSTA Reimbursement Request Form - Documentation from your physician's office showing: - The product code - The amount you paid out-of-pocket - Your FDA-approved diagnosis (glaucoma or ocular hypertension) ## Timeline and Processing Once your doctor's office submits all required documentation, here's what to expect: - **Submission deadline**: Claims must be submitted within 365 days of your DURYSTA procedure - **Processing time**: Estimated 3 days for ACH (electronic) transfer or 2-4 weeks for check payment - **Reimbursement method**: Your doctor's office receives reimbursement directly ## What If Your Application Is Denied? If you don't qualify for the DURYSTA Savings Program, you may have other options: - **Contact Allergan EyeCue**: This comprehensive resource provides 24/7 reimbursement assistance and can help identify other patient financial support options - **Check with your insurance**: Ask your insurance company about coverage options or appeals - **Speak with your eye doctor**: Your doctor's office may know of additional assistance programs or payment plans ## Important Information About Program Changes If your insurance coverage changes at any time—for example, if you become eligible for Medicare or Medicaid—you must immediately call the program at **1-833-DURYSTA (833-387-9782), option 2** to stop your participation. Continuing to use the program after your eligibility ends could result in complications with your coverage. ## Contact Information For questions about the DURYSTA Savings Program: - **Phone**: 1-833-DURYSTA (833-387-9782), option 2 - **Website**: DurystaSavingsProgram.com - **Reimbursement support**: AllerganEyeCue.com Your eye doctor's office can also answer questions about enrollment and eligibility. ## Important Disclaimer This guide provides general information about the DURYSTA Savings Program. Program terms, eligibility requirements, and benefits may change. For the most current and complete information, visit DurystaSavingsProgram.com or call 1-833-DURYSTA. Always consult with your eye doctor and insurance company to confirm your eligibility and coverage before your procedure. This information is not a guarantee of program enrollment or cost assistance.

Program information last verified: March 30, 2026