SUPPORT: WAYS TO SAVE ON CEQUA®

CEQUA has affordability options for ALL your insured patients

PhilRx provides prior authorization (PA) support services and the lowest possible price for CEQUAa,b

CEQUA copay card coupon
 
Approved PAa:

Your patient will receive lowest CEQUA Co-pay Card pricing based on their commercial insurance coverage (as low as $0 co-pay).

 

CEQUA PhilRx copay card
 
Denied PAb:

Your patient will be offered cash discount pricing at only $89 per box (60 vials).

The benefits of PhilRx:

Easy prescribing via Electronic Health Records (EHR)—no forms

Best affordability options are determined for the patient and automatically applied through PhilRx

  • Commercial insurance patients may pay as little as $0 per month for each box of CEQUA (60 vials)
  • Medicare Part D patients may be eligible for a manufacturer cash discount price of only $89 per box (60 vials) if their PA is deniedc

Patients opt in to the program directly with PhilRx—no need to burden your office staff. Plus, free delivery

See how access to CEQUA can be more streamlined for you and your patients

Questions? Please see PhilRx FAQs

 

For commercially insured patients, you can still prescribe CEQUA to their local retail pharmacya

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.

See directions for activating the co-pay card.

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.

Connect with a CEQUA sales representative

Request a Rep

Co-pay Program Terms & Conditions 

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

  • To participate in this Program, you must have commercial health insurance and be a resident of the United States, Puerto Rico, Guam, or the Virgin Islands
  • The following patients are ineligible for this Program
    • Patients covered under Medicaid (including Medicaid patients enrolled in a Medicaid Managed Care Plan or a qualified health plan purchased through a health insurance exchange marketplace established by a state government or the federal government)
    • Patients covered by Medicare or a Medicare Part D or Medicare Advantage plan (regardless of whether a specific prescription is covered)
    • Patients covered by TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program
    • Patients who are members of health plans that claim to eliminate their out-of-pocket costs are not eligible for cost support. If you are a member of one of these plans, please call 1-877-264-2440
    • Patients with no insurance

Terms and Conditions

  • You agree to not seek any reimbursement for all or any part of the co-pay assistance received through the Program. By using this card, you are certifying that you understand the Eligibility Rules and Terms and Conditions, that you have responded truthfully to questions when activating the card, and that you will disclose and report your receipt of any Program benefits to your insurer, health plan, or any third party that pays or reimburses you for the cost of medications, if required
  • This offer may be rescinded, revoked, or cancelled at any time, without further notice, and the rules may be amended at any time, without further notice

Disclosures

  • This Program is not insurance
  • The Program is void where prohibited by law, taxed, or restricted. Any benefit provided is not transferable and cannot be combined with any other program, free trial, discount, prescription savings card, or other offer. No purchase, other than for a CEQUA prescription, is required to participate
  • Personal data that you provide to the Program may be collected, analyzed, and shared with the program sponsor for market research and other lawful purposes, but only in aggregated and de-identified form
 
Indications and Usage

CEQUA® (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

CEQUA® (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.

© 2024 Sun Ophthalmics, a division of Sun Pharmaceutical Industries, Inc. All rights reserved.

CEQUA and NCELL are registered trademarks of Sun Pharmaceutical Industries Limited.

All other trademarks are the property of their respective owners.

PM-US-CQA-1124 07/2024