Verkazia

Indicated For

vernal keratoconjunctivitis

About This Medication

# Patient Assistance Program (PAP) Patient Guide: How to Get Verkazia at Low or No Cost ## About Verkazia Verkazia (cyclosporine ophthalmic emulsion) 0.1% is the first and only topical immunomodulator FDA-approved to treat vernal keratoconjunctivitis (VKC) in children and adults.[2][3] VKC is an inflammatory eye condition that causes symptoms like itching, light sensitivity, tearing, and mucous discharge. Verkazia works by helping to stop the activity in the immune system that causes these VKC symptoms, and it's designed to be used four times daily.[2] In clinical trials, Verkazia helped improve symptoms within the first month of use and reduced inflammation that can damage the cornea.[2] The medication has an established 12-month safety profile with low rates of mild-to-moderate adverse events.[3] ## Who Qualifies for the Patient Assistance Program Harrow's Patient Assistance Program (PAP) is designed to help patients who are **uninsured or underinsured** access Verkazia at reduced or no cost.[5] This program recognizes that medication affordability is a barrier for many patients and aims to ensure that financial constraints don't prevent you from receiving the treatment your doctor has prescribed. If you have insurance but face high out-of-pocket costs, you may also qualify for the **Commercial Copay/Coinsurance Assistance Program**, which can help reduce your copayments or coinsurance amounts.[5] ## Income Eligibility While specific income thresholds are not publicly listed, the PAP evaluates financial need on a case-by-case basis. During the application process, you'll be asked to provide proof of income so the program can determine your eligibility. The program considers your household size and financial situation when making eligibility decisions. ## Insurance Requirements To qualify for the PAP, you must be either: - **Uninsured** (no health insurance coverage) - **Underinsured** (have insurance but face significant out-of-pocket costs) If you have commercial insurance, you may be eligible for the Commercial Copay/Coinsurance Assistance Program instead, which helps reduce your copayment or coinsurance obligations.[5] ## How to Apply for the Patient Assistance Program ### Step 1: Gather Required Documents Before starting your application, collect the following: - **Proof of income** (recent pay stubs, tax returns, or benefit statements) - **Proof of insurance status** (insurance card or letter stating you are uninsured) - **Valid prescription** for Verkazia from your ophthalmologist or eye care provider ### Step 2: Complete the Patient Referral Form You can apply through multiple methods: - **By phone:** Call the Verkazia Patient Support Program at **1-833-577-7277** or Harrow at **1-833-442-7769** to request an application or apply over the phone - **By mail:** Request a Patient Referral Form and submit it by mail with your supporting documents - **With your healthcare provider:** Your doctor's office may help you complete and submit the form The Patient Referral Form collects information about: - Your personal and contact information - Your insurance status and coverage details - Your prescriber's information - Your medical history and current medications - Your authorization for the program to contact your insurance company and coordinate with your pharmacy ### Step 3: Submit Your Application Once completed, submit your application along with copies of your required documents. You can submit by: - **Phone:** 1-833-577-7277 (Verkazia Patient Support Program) or 1-833-442-7769 (Harrow) - **Mail:** PO Box 5490, Louisville, KY 40255 - **Through your pharmacy or healthcare provider** ### Step 4: Authorization and Verification When you submit your application, you authorize the program to: - Contact your insurance company to verify your coverage - Determine your eligibility for assistance programs - Verify your financial information - Coordinate your treatment with your healthcare provider and specialty pharmacy - Send you educational materials and refill reminders Your authorization is valid for five years from the date you sign it, and you can cancel at any time by mailing a letter to the address above.[5] ## Timeline and Delivery While specific processing timelines are not publicly available, the program works to process applications efficiently. Once approved, your medication will be coordinated through a specialty pharmacy. The program will work with your healthcare provider and pharmacy to ensure you receive your Verkazia as quickly as possible. For ongoing support, a care coordinator may contact you by telephone, email, or text to provide personalized assistance and refill reminders to help you stay on your treatment plan.[5] ## What If Your Application Is Denied If you don't qualify for the PAP, you may have other options: - **Commercial Copay/Coinsurance Assistance Program:** If you have insurance, you may qualify for this program to reduce your out-of-pocket costs - **Reapplication:** Your financial situation may change, and you can reapply in the future - **Contact Harrow directly:** Call 1-833-442-7769 to discuss your specific situation and explore other potential assistance options ## Important Information **Medication Dosing:** Verkazia is typically prescribed as one drop in each affected eye four times daily. Your doctor will determine how long you should take Verkazia based on your individual condition.[2] **Common Side Effects:** The most common side effects reported in clinical trials were eye pain (12%) and eye itching (8%), which were usually temporary and occurred during instillation.[1][3] **Reporting Side Effects:** If you experience any side effects, report them to Harrow at 1-833-442-7769 or to the FDA at 1-800-FDA-1088. ## Disclaimer This guide provides general information about Harrow's Patient Assistance Program for Verkazia. Program details, eligibility requirements, and benefits may change. For the most current and complete information, contact the Verkazia Patient Support Program at 1-833-577-7277 or Harrow at 1-833-442-7769. Always consult with your healthcare provider about your treatment options and financial assistance programs. This information is not a substitute for professional medical advice.

Program information last verified: March 29, 2026