Retisert

RETISERT™ Reimbursement and Patient Assistance Program: How to Get Retisert at Low or No Cost

About This Program

The RETISERT™ Reimbursement and Patient Assistance Program, offered by Bausch + Lomb, is designed to help patients access Retisert (fluocinolone acetonide intravitreal implant) at reduced or no cost. Retisert is a prescription medication used to treat chronic noninfectious uveitis affecting the posterior segment of the eye. This program ensures that financial constraints do not prevent eligible patients from receiving this important treatment.

Who Qualifies for Assistance

The RETISERT™ program provides assistance to financially needy patients who meet eligibility criteria. While specific income thresholds are not publicly listed, the program evaluates each patient's financial situation individually to determine eligibility.

You may qualify if you:

• Have limited financial resources
• Lack adequate insurance coverage for Retisert
• Have insurance that does not cover this medication
• Are experiencing financial hardship

The program serves patients with various insurance statuses, including those who are uninsured, underinsured, or have insurance plans that do not cover Retisert.

About Retisert

Retisert is a corticosteroid implant placed directly in the eye to treat chronic noninfectious uveitis. The implant releases fluocinolone acetonide gradually over an extended period, helping to reduce inflammation and manage symptoms. This specialized treatment requires a prescription from your ophthalmologist or eye care specialist.

Insurance Requirements and Coverage

The program works with patients who have various insurance situations:

If you have insurance, the program will verify your benefits to determine what assistance you may need. The program does not replace insurance but supplements coverage for eligible patients.

Income Eligibility

While the program does not publish specific income thresholds, eligibility is based on financial need. The program evaluates your individual circumstances, including:

• Household income
• Family size
• Monthly expenses
• Other financial obligations

If you are uncertain whether you qualify, contact the program directly at (866) 250-2974 to discuss your situation with a program representative.

Required Documents for Application

To apply for the RETISERT™ program, you will need to provide:

1. Proof of Financial Need: Documentation such as recent tax returns, pay stubs, bank statements, or a signed financial declaration
2. Insurance Information: Current insurance card(s) or proof of lack of insurance
3. Physician Prescription: A valid prescription for Retisert from your ophthalmologist
4. Patient Declaration: A signed statement confirming your financial situation and need for assistance

Have these documents ready before starting your application to streamline the process.

How to Apply

Applying for the RETISERT™ program is straightforward:

Step 1: Gather Required Documents Collect proof of financial need, insurance information, your prescription, and prepare to sign a patient declaration.

Step 2: Contact the Program Call the program at (866) 250-2974 to request an application form by mail, or mail your completed application directly to the program address provided by Bausch + Lomb.

Step 3: Complete Your Application Fill out all required fields on the application form. Be thorough and accurate when describing your financial situation, as this information determines eligibility.

Step 4: Submit Your Application Mail your completed application along with supporting documents to the address provided. There is no cost to apply.

Step 5: Await Approval Notification The program will review your application and notify you of the decision. Keep your contact information current so you receive updates.

Application Timeline and Medication Delivery

While specific processing times are not publicly listed, most patient assistance programs review applications within 1-2 weeks. Once approved, your Retisert will be shipped directly to your physician's office, where it will be stored until your scheduled implantation procedure.

There are no copays or shipping fees for approved patients. Your physician will coordinate with the program regarding delivery timing to ensure the medication arrives when needed for your procedure.

What Happens If Your Application Is Denied

If your application is denied, you have options:

1. Request Reconsideration: Contact the program to understand the reason for denial and ask if additional information could support reconsideration
2. Reapply: If your financial situation changes, you may reapply in the future
3. Explore Alternatives: Ask your ophthalmologist about other treatment options or other patient assistance resources
4. Contact Patient Advocacy: Organizations focused on eye health may offer additional resources or guidance

Do not hesitate to call (866) 250-2974 to discuss denial reasons and next steps.

Reauthorization and Ongoing Assistance

If you are approved and receive Retisert through this program, you may be eligible for continued assistance if needed in the future. Contact the program to discuss reauthorization options and any changes to your eligibility status.

Important Disclaimer

This guide provides general information about the RETISERT™ Reimbursement and Patient Assistance Program. Program details, eligibility criteria, and benefits may change. For the most current and accurate information, contact Bausch + Lomb directly at (866) 250-2974. This guide is not a guarantee of eligibility or assistance. Your ophthalmologist can also provide information about this program and help determine if you qualify. Always consult with your healthcare provider regarding your treatment options and financial assistance programs.