Xeomin

Indicated For

blepharospasm, cervical dystonia

About This Medication

# XEOMIN Patient Assistance Program Patient Guide: How to Get Xeomin (incobotulinumtoxinA) at Low or No Cost Xeomin (incobotulinumtoxinA) is a prescription botulinum toxin type A injection used to treat conditions like **cervical dystonia**, **upper limb spasticity**, **blepharospasm**, and **chronic sialorrhea** in adults, as well as lower limb spasticity in children aged 2 years and older.[1][2] The **XEOMIN Patient Assistance Program (PAP)** from Merz Pharmaceuticals, LLC, provides Xeomin **at no charge** to eligible uninsured or underinsured patients who meet financial and other criteria based on Federal Poverty Guidelines (FPG).[1][2][9] ## Who Qualifies for the XEOMIN Patient Assistance Program? This program is designed for patients facing financial hardship who cannot afford their Xeomin treatment. Key eligibility factors include: - **Financial need**: Household income must meet thresholds based on the **Federal Poverty Guidelines (FPG)**. Exact percentages (e.g., 400% FPG) are not specified publicly; eligibility is determined during enrollment.[1][9] - **Insurance status**: Must be **uninsured or underinsured**. Patients enrolled in **Medicare, Medicaid, or other government-funded programs** are **not eligible**.[2][4][9] - **Residency**: U.S. residents (including Puerto Rico).[9] - **Medical need**: Must have a valid prescription for an FDA-approved Xeomin indication and meet clinical guidelines set by Merz.[2] - **Age**: Generally applicable to adults and children (at least 2 years old for certain indications).[7] **Important**: If underinsured, your doctor must complete specific steps before approval. Acceptance does not guarantee indefinite assistance; eligibility must be re-established **every 12 months**, and aid can be terminated anytime.[1][2][3][4] ## About Xeomin (incobotulinumtoxinA) **Xeomin** is a purified form of botulinum toxin type A, free of complexing proteins, which may reduce the risk of antibody formation over time. It's injected by a healthcare professional to temporarily improve muscle stiffness and spasms in conditions like: - Cervical dystonia (neck muscle spasms) - Blepharospasm (eyelid spasms) - Upper and lower limb spasticity - Chronic sialorrhea (excessive drooling) Treatments are typically repeated every 3-4 months. Always discuss benefits, risks (e.g., muscle weakness, swallowing difficulties), and alternatives with your doctor. For full details, refer to the prescribing information.[1][2] ## Income Eligibility Breakdown Eligibility is tied to **Federal Poverty Guidelines (FPG)**, updated annually by the U.S. Department of Health & Human Services. Specific income thresholds or FPG percentages are **not publicly detailed** by Merz; they assess on a case-by-case basis during application.[1][9] Here's a general example table based on 2026 FPG (illustrative; confirm current guidelines at ASPE.hhs.gov): | Household Size | 100% FPG (Annual Income) | 300% FPG (Example Threshold) | 400% FPG (Common Max) | |---------------|---------------------------|------------------------------|-----------------------| | 1 (Individual) | $15,060 | $45,180 | $60,240 | | 2 (Couple) | $20,440 | $61,320 | $81,760 | | 3 | $25,820 | $77,460 | $103,280 | | 4 | $31,200 | $93,600 | $124,800 | *Notes*: Add ~$5,380 per additional person for FPG. Merz uses these to set limits (e.g., up to 400-500% FPG common in PAPs). Provide **proof of income** (tax returns, pay stubs) for verification. Call (855) 463-7989 for your situation.[1][9] ## Insurance Requirements - **Uninsured**: Fully qualify if income-eligible. - **Underinsured**: Commercial/private insurance OK, but **not government programs** (Medicare Part D, Medicaid, VA, Tricare, etc.). If coverage changes to government-funded, you **must notify** and stop participation.[2][4][9] - Your doctor may need to confirm prior authorization or coverage denial steps for underinsured cases.[1] ## Step-by-Step Application Process 1. **Talk to your doctor**: Confirm Xeomin is right for you. They must prescribe it and may need to complete parts of the form, especially if underinsured.[1][2] 2. **Download or request form**: Get the enrollment form from merzconnect.com or call (855) 463-7989 (option 4, Mon-Fri 8am-7pm ET).[1][9] 3. **Gather documents**: - Completed enrollment form (patient and doctor signatures). - **Proof of income** (W-2, 1040, pay stubs, SSI award letter). - **Proof of residency** (utility bill, lease). - **Proof of insurance status** (insurance card or denial letter; confirm no government coverage).[9] 4. **Submit**: Fax to 855-825-0488 or as instructed. Multiple methods available (phone, download).[1][9] 5. **Wait for approval**: MERZ CONNECT reviews; report status changes within 30 days.[4] ## Timeline and Delivery - **Processing time**: Not specified; typically 2-4 weeks for PAPs, but call for updates.[1] - **Delivery**: Xeomin vials **shipped free** to your **home or doctor's office**.[Program details] - **Reauthorization**: **Required every 12 months**. Submit updated docs before refill.[1][2][3][4] ## Alternatives if Denied - **Merz Patient Savings Program**: For **commercially insured** patients (not uninsured/PAP); save up to **$5,000/year** on copays/deductibles (as low as $0 OOP).[2][3][5] - **Other PAPs**: Check rxassist.org or needymeds.org for generics/alternatives.[6] - **State programs**, **manufacturer copay cards**, or **specialty pharmacies**. - **Appeals**: Contact MERZ CONNECT to discuss denial reasons and resubmit.[1] - **Biosimilars**: None currently available.[Program details] ## Disclaimer This guide is for informational purposes only and based on publicly available data as of 2026. **Program terms can change**; Merz reserves rights to modify eligibility or terminate aid. **Not health insurance** or medical advice—consult your doctor. Criteria set by Merz Pharmaceuticals, LLC. For latest details, call **(855) 463-7989** or visit merzconnect.com. Report income/insurance changes promptly. (Word count: 1028)

Program information last verified: March 30, 2026