SUPPORT: WAYS TO SAVE ON CEQUA®
Your patient will receive lowest CEQUA Co-pay Card pricing based on their commercial insurance coverage (as low as $0 co-pay).
Your patient will be offered cash discount pricing at only $89 per box (60 vials).
Easy prescribing via Electronic Health Records (EHR)—no forms
Best affordability options are determined for the patient and automatically applied through PhilRx
Patients opt in to the program directly with PhilRx—no need to burden your office staff. Plus, free delivery
Your patient will not be enrolled in PhilRx and will not have access to the manufacturer cash discount program
Patients will need to activate the CEQUA Co-pay Card savings offer online
Patients must fill out the form at cequa.com/cost to get the savings offer, then present it to the pharmacy when they pick up their prescription. If they're eligible, the savings offer will be ready to use immediately.
aEligibility rules apply. Co-pay cards are only available with commercial insurance. Maximum benefit is $250 per prescription. 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 below.
bPhilRx is a third-party vendor. By participating in the program, patients acknowledge that they currently meet the eligibility criteria. This program is only available for eligible commercially or Medicare Part D insured patients who are prescribed CEQUA through PhilRx.
cMedicare patients may be eligible for manufacturer cash discount pricing in case their plan does not cover CEQUA as a benefit and there is a confirmed PA denial. Subject to patient agreeing to program terms and conditions for opt out.
To participate in the CEQUA® (cyclosporine ophthalmic solution) 0.09% Co-pay Program (“Program”), you must present this card, along with a valid prescription for CEQUA, to your pharmacist. Patients with commercial health insurance who qualify to participate may pay as little as $0 for 60 vials (1 box) of CEQUA. Enrollment is subject to the Eligibility Rules and Terms and Conditions, stated below. If you have any questions regarding Eligibility, the Terms and Conditions, or to discontinue participation, please call 855-268-1426 (8:00 AM–8:00 PM EST, Monday–Friday).
Eligibility Rules
Terms and Conditions
Disclosures
CEQUA® (cyclosporine ophthalmic solution) 0.09% is a calcineurin inhibitor immunosuppressant indicated to increase tear production in patients with keratoconjunctivitis sicca (dry eye).
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.
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.
CEQUA® (cyclosporine ophthalmic solution) 0.09% is a calcineurin inhibitor immunosuppressant indicated to increase tear production in patients with keratoconjunctivitis sicca (dry eye).
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.
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.