SAVINGS: WAYS TO SAVE ON CEQUATM

CEQUA Savings logo

Great ways to help your patients save on CEQUA

Eligible patients can pay as little as $0 with a
copay card

  • Commercially insured patients can fill their CEQUA prescription at any retail pharmacy near them and receive a discount by activating a copay card.
  • They could pay as little as $0 per month for each box of CEQUA (60 vials).a Maximum benefit is $250 per prescription.
  • The copay card must be activated to work. To activate the card, you or your patients may call 1-855-268-1426 or visit CEQUA.com/savings and fill out the appropriate information.
CEQUA savings card

Savings options through CoverMyMeds partnership – Prior Authorization
Support Services

  • Give your patients affordability options by completing a Prior Authorization (PA) in CoverMyMeds. Be sure to enter your patient’s email address in the “affordability” box and ScriptHero will take care of the rest.

Approved

Plan approves Prior
Authorization

  • Once a patient’s commercial plan approves the PA, ScriptHero will email your patient to share relevant affordability options where they could pay as little as $0 per month for each box of CEQUA (60 vials).a
  • For patients with Medicare, a cost estimate is shared upon PA approval so there are no surprises at the pharmacy.

Denied

Plan denies Prior
Authorization

  • When coverage falls short, eligible commercial and Medicare patients can enroll in a sponsored cash discount program to use as an alternative, lowering the cost to $89 per box.

Approved

Plan approves Prior Authorization

  • Once a patient’s commercial plan approves the PA, ScriptHero will email your patient to share relevant affordability options where they could pay as little as $0 per month for each box of CEQUA (60 vials).a
  • For patients with Medicare, a cost estimate is shared upon PA approval so there are no surprises at the pharmacy.

Denied

Plan denies Prior Authorization

  • When coverage falls short, eligible commercial and Medicare patients can enroll in a sponsored cash discount program to use as an alternative, lowering the cost to $89 per box.

aEligibility rules apply. Not valid for patients paying cash or with government insurance including, but not limited to, Medicare or Medicaid. Patients must reside in the United States, Puerto Rico, Guam, or the Virgin Islands.

Please read full Terms and Conditions.

To learn more, visit scripthero.com/providers/cequa

Find more information on submitting a Prior Authorization and helpful billing codes.

Office Information
Indications and Usage

CEQUATM (cyclosporine ophthalmic solution) 0.09% is a calcineurin inhibitor immunosuppressant indicated to increase tear production in patients with keratoconjunctivitis sicca (dry eye).

Important Safety Information

Warnings and Precautions

Potential for Eye Injury and Contamination: To avoid the potential for eye injury and contamination, advise patients not to touch the vial tip to the eye or other surfaces.

Use with Contact Lenses: CEQUA should not be administered while wearing contact lenses. If contact lenses are worn, they should be removed prior to administration of the solution. Lenses may be reinserted 15 minutes following administration of CEQUA ophthalmic solution.

Adverse Reactions

The most common adverse reactions reported in greater than 5% of patients were pain on instillation of drops (22%) and conjunctival hyperemia (6%). Other adverse reactions reported in 1% to 5% of patients were blepharitis, eye irritation, headache, and urinary tract infection.

Please see the Full Prescribing Information.

Indications and Usage

CEQUATM (cyclosporine ophthalmic solution) 0.09% is a calcineurin inhibitor immunosuppressant indicated to increase tear production in patients with keratoconjunctivitis sicca (dry eye).

Important Safety Information

Warnings and Precautions

Potential for Eye Injury and Contamination: To avoid the potential for eye injury and contamination, advise patients not to touch the vial tip to the eye or other surfaces.

Use with Contact Lenses: CEQUA should not be administered while wearing contact lenses. If contact lenses are worn, they should be removed prior to administration of the solution. Lenses may be reinserted 15 minutes following administration of CEQUA ophthalmic solution.

Adverse Reactions

The most common adverse reactions reported in greater than 5% of patients were pain on instillation of drops (22%) and conjunctival hyperemia (6%). Other adverse reactions reported in 1% to 5% of patients were blepharitis, eye irritation, headache, and urinary tract infection.

Please see the Full Prescribing Information.