THE BOTOX® SAVINGS PROGRAM FOR
ELIGIBLE PATIENTS WITH STRABISMUS

Program Details

The BOTOX® Savings Program helps eligible patients save on out-of-pocket costs for BOTOX® treatment that are not covered by insurance.*
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STEP 1

See if you are eligible

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STEP 2

Enroll

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STEP 3

Get treated, receive your EOB in the mail, submit your claim to us for review

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STEP 4

If approved, receive a check from the BOTOX® Savings Program in the mail

*Maximum savings limit applies; patient out-of-pocket expense may vary. Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs. Please see Program Terms, Conditions, and Eligibility Criteria.

What It Covers

The BOTOX® Savings Program helps reduce treatment-related expenses for BOTOX®

Savings for eligible patients with strabismus*

up to$150 per treatment

enough to cover remaining out-of-pocket costs so many patients pay

$0

*Maximum savings limit applies; patient out-of-pocket expense may vary. Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs. Please see Program Terms, Conditions, and Eligibility Criteria.

Coverage and out-of-pocket cost vary.

Frequently Asked Questions

We are excited to have a new and improved patient savings program to offer eligible patients who are getting treated with BOTOX®. The new program is more efficient to make the process quick and easy for patients.

  • 1. First, check if you are eligible with a few quick questions.
  • 2. If you are eligible, we’ll ask you for some additional information, like your contact information, physician, and insurance information. The information pertaining to you that we collect will be used in accordance with the Allergan Privacy Statement, which can be found at www.allergan.com/privacy.
  • 3. Once you’ve been treated with BOTOX® and have received an Explanation of Benefits (EOB) from your insurance company, let us know via this website, and we will begin a treatment claim verification for you. This is why we need your insurance information during enrollment, so that we can do this on your behalf.
  • 4. We will verify your treatment claim with your insurance on your behalf.
  • 5. If your claim is approved based on review with insurance—we need to confirm you received BOTOX® treatment for an FDA-approved indication—we will mail you a check for your treatment costs up to the amount allowed for your condition. If for some reason your claim is not approved, we will let you know why.
  • 6. Following each future treatment with BOTOX®, you can submit each claim to our program and follow the same process.
  • 7. We will keep you updated at each step of the way by email and/or text messages based on your communication preference, so you know where your claim is at any time.
  • 8. For any additional questions, please see further details below. If you still have a question, simply call us at 1-800-44-BOTOX, and our customer service team will be glad to help.

You can enroll quickly and easily at BotoxSavingsProgram.com. You’ll start by checking your eligibility. If you’re eligible, you’ll be led through the enrollment process. If you’d prefer to enroll by phone, just call 1-800-44-BOTOX (1-800-442-6869) and you’ll be connected with a representative.

You are eligible if you:

  • - Are currently receiving BOTOX® treatment for an FDA-approved indication for BOTOX®
  • - Are commercially insured
  • - Are not enrolled in or eligible for Medicare, Medicaid, or other federal or state healthcare programs
  • - Are 18 years or older
  • - Receive treatment in the United States or Puerto Rico (void where prohibited by law, taxed, or restricted)
  • - Please see full Terms and Conditions

In most cases, it's as simple as submitting an online claim form that needs to be approved. If neccessary, we may require additional documentation. If your claim is approved, you may either receive your BOTOX® Savings Program check in the mail or the check may be sent directly to your doctor on your behalf (depending on the option you choose while submitting your claim). Your check should be delivered within 2 to 3 weeks after your claim is approved.

Your check should be delivered within 2 to 3 weeks after your claim is approved.

Yes, your BOTOX® Savings Program check can be sent directly to your doctor to help cover any out-of-pocket costs for your treatment not covered by insurance. If you would prefer this, make sure you choose this option when submitting your claim online.

Depending on your computer’s configuration, you may need to scroll down the page in order to complete the forms. If you are having difficulty, you can try using the arrow keys on your keyboard to scroll down the page. Alternatively, you can try moving the scroll bar on the right-hand side of the browser window using your mouse.

The BOTOX® Savings Card has been replaced with the BOTOX® Savings Program. If you received this letter it is because you are enrolled in BOTOX® Savings Card. You will need to log-in (vs. enroll) to BotoxSavingsProgram.com using your email address and password from BotoxSavingsCard.com. Once logged in, you need to complete re-enrollment by accepting the new program terms and conditions, then provide a few additional pieces of information.

Your username and password are the same as what you used to access BotoxSavingsCard.com. The username is the email address that you used to register for that program. If you have forgotten your password, click “Log In” at the top right portion of BotoxSavingsProgram.com screen, then scroll down to click “Forgot Password”. Using the form will send a temporary password to the email address you used to register for BotoxSavingsCard.com.

Please complete the re-enrollment process to ensure the review of your claim. Once logged into BotoxSavingsProgram.com, you will be able to access your personalized dashboard where you can check the status of your claim and receive personalized updates regarding its progress. If you are unable to see your claim on your Member Dashboard, select the Activity History tab to view your complete claim history for the past two years.

Yes. All claims must be submitted within 90 days from the date on your Explanation of Benefits (EOB) form, which you’ll receive from your insurance provider.

An EOB is sent to you by your insurance provider after your healthcare service or visit. It explains what medical treatments and/or services were paid by your insurance provider and whether you have any out-of-pocket costs. An EOB may also have information about your deductible. Your deductible is the amount that your insurance provider requires you to pay out-of-pocket before they will pay any expenses. If you don't know how much your deductible is or how much you've already paid, you can find out by contacting your insurance provider. An EOB will also contain your claim number, which you will need in order to submit a claim. The claim number will typically be near the top of the EOB. It may also be listed with the details for each date of service included on the EOB.

An SPP receipt is issued by companies that provide specialty pharmaceuticals like BOTOX®. Ask your doctor if you are unsure whether or not you’re using an SPP. You can get an SPP receipt by contacting your Specialty Pharmacy Provider.

Eligible patients can get up to $150 per treatment. You can use the BOTOX® Savings Program for up to 4 treatments and/or related procedures in a 12-month period.

You will not receive more than what you paid for treatment, which can be found on the Explanation of Benefits (EOB) form you’ll receive from your insurance provider. If your claim is approved, the amount you receive will be based on how much you paid in out-of-pocket expenses for your BOTOX® treatment. For example, if your eligible out-of-pocket expenses were $150, your BOTOX® Savings Program check will be for $150. Please note the amount you pay and the amount you receive may vary from treatment to treatment. Eligibility amounts reflect current program offerings and are subject to cancellation by Allergan at any time. Maximum limits are applicable for each indication.

Yes, the BOTOX® Savings Program helps eligible patients save on out-of-pocket costs related to both BOTOX® medicine and/or related procedure not covered by insurance. These costs are sometimes billed separately from one another. The BOTOX® Savings Program does not provide help for office visit co-pay costs.

If you do not receive your BOTOX® Savings Program check within 10 to 15 days of submitting a claim, call 1-800-44-BOTOX, and you’ll be connected with a representative.

You can report your lost or stolen BOTOX® Savings Program check and request a new one by phone. Simply call 1-800-44-BOTOX, and you’ll be connected with a representative.

Please go to SavingsCardBalance.com to check the balance on your card, card status, card expiration date, and card transaction history.

Please note, you may use your current BOTOX® Savings Card through February 28, 2018, unless an earlier expiration date is noted on the card (for example, January 31, 2018). If you have a remaining balance on your BOTOX® Savings Card after February 28th, you will receive a check in the mail for that amount after the card expiration.

Allergan and its authorized partners use the information you provide for legitimate business purposes only and will not sell, share, or otherwise distribute your personal information to third parties. Please see our Privacy Policy and Terms of Use for more information.

You can speak with a representative Monday through Friday, from 9 AM to 8 PM ET. Simply call 1-800-44-BOTOX, and you’ll be connected with a representative.


BOTOX® (onabotulinumtoxinA) Important Information

Indications
BOTOX® is a prescription medicine that is injected into muscles and used:

  • to treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency), and urinating often (frequency) in adults 18 years and older when another type of medicine (anticholinergic) does not work well enough or cannot be taken
  • to treat leakage of urine (incontinence) in adults 18 years and older with overactive bladder due to neurologic disease who still have leakage or cannot tolerate the side effects after trying an anticholinergic medication
  • to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years or older
  • to treat increased muscle stiffness in elbow, wrist, finger, and thumb muscles in people 18 years and older with upper limb spasticity
  • to treat increased muscle stiffness in ankle and toe muscles in people 18 years and older with lower limb spasticity
  • to treat the abnormal head position and neck pain that happens with cervical dystonia (CD) in people 16 years and older
  • to treat certain types of eye muscle problems (strabismus) or abnormal spasm of the eyelids (blepharospasm) in people 12 years and older

BOTOX® is also injected into the skin to treat the symptoms of severe underarm sweating (severe primary axillary hyperhidrosis) when medicines used on the skin (topical) do not work well enough in people 18 years and older.

It is not known whether BOTOX® is safe or effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine).

It is not known whether BOTOX® is safe or effective to treat increased stiffness in upper limb muscles other than those in the elbow, wrist, fingers, and thumb, or in lower limb muscles other than those in the ankle and toes. BOTOX® has not been shown to help people perform task-specific functions with their upper limbs or increase movement in joints that are permanently fixed in position by stiff muscles. Treatment with BOTOX® is not meant to replace existing physical therapy or other rehabilitation that may have been prescribed.

It is not known whether BOTOX® is safe or effective for other types of muscle spasms or for severe sweating anywhere other than your armpits.

IMPORTANT SAFETY INFORMATION

BOTOX® may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX®:

  • Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months.
  • Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing.

There has not been a confirmed serious case of spread of toxin effect away from the injection site when BOTOX® has been used at the recommended dose to treat chronic migraine, severe underarm sweating, blepharospasm, or strabismus.

BOTOX® may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of taking BOTOX®. If this happens, do not drive a car, operate machinery, or do other dangerous activities.

Do not receive BOTOX® if you: are allergic to any of the ingredients in BOTOX® (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® (rimabotulinumtoxinB), Dysport® (abobotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have a skin infection at the planned injection site.

Do not receive BOTOX® for the treatment of urinary incontinence if you: have a urinary tract infection (UTI) or cannot empty your bladder on your own and are not routinely catheterizing.

Due to the risk of urinary retention (not being able to empty the bladder), only patients who are willing and able to initiate catheterization post-treatment, if required, should be considered for treatment.

Patients treated for overactive bladder
In clinical trials, 36 of the 552 patients had to self-catheterize for urinary retention following treatment with BOTOX® compared to 2 of the 542 treated with placebo.

Patients with diabetes mellitus treated with BOTOX® were more likely to develop urinary retention than non-diabetics.

Patients treated for overactive bladder due to neurologic disease
In clinical trials, 30.6% of patients (33/108) who were not using clean intermittent catheterization (CIC) prior to injection, required catheterization for urinary retention following treatment with BOTOX® 200 Units as compared to 6.7% of patients (7/104) treated with placebo. The median duration of post-injection catheterization for these patients treated with BOTOX® 200 Units (n = 33) was 289 days (minimum 1 day to maximum 530 days) as compared to a median duration of 358 days (minimum 2 days to maximum 379 days) for patients receiving placebo (n = 7).

Among patients not using CIC at baseline, those with MS were more likely to require CIC post-injection than those with SCI.

The dose of BOTOX® is not the same as, or comparable to, another botulinum toxin product.

Serious and/or immediate allergic reactions have been reported including itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Get medical help right away if you experience symptoms; further injection of BOTOX® should be discontinued.

Tell your doctor about all your muscle or nerve conditions such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including difficulty swallowing and difficulty breathing from typical doses of BOTOX®.

Tell your doctor if you have any breathing-related problems. Your doctor may monitor you for breathing problems during your treatment with BOTOX® for spasticity or for detrusor overactivity associated with a neurologic condition. The risk of developing lung disease in patients with reduced lung function is increased in patients receiving BOTOX®.

Cornea problems have been reported. Cornea (surface of the eye) problems have been reported in some people receiving BOTOX® for their blepharospasm, especially in people with certain nerve disorders. BOTOX® may cause the eyelids to blink less, which could lead to the surface of the eye being exposed to air more than is usual. Tell your doctor if you experience any problems with your eyes while receiving BOTOX®. Your doctor may treat your eyes with drops, ointments, contact lenses, or with an eye patch.

Bleeding behind the eye has been reported. Bleeding behind the eyeball has been reported in some people receiving BOTOX® for their strabismus. Tell your doctor if you notice any new visual problems while receiving BOTOX®.

Bronchitis and upper respiratory tract infections (common colds) have been reported. Bronchitis was reported more frequently in people receiving BOTOX® for upper limb spasticity. Upper respiratory infections were also reported more frequently in people with prior breathing related problems with spasticity.

Autonomic dysreflexia in patients treated for overactive bladder due to neurologic disease
Autonomic dysreflexia associated with intradetrusor injections of BOTOX® could occur in patients treated for detrusor overactivity associated with a neurologic condition and may require prompt medical therapy. In clinical trials, the incidence of autonomic dysreflexia was greater in patients treated with BOTOX® 200 Units compared with placebo (1.5% versus 0.4%, respectively).

Tell your doctor about all your medical conditions, including if you: have or have had bleeding problems; have plans to have surgery; had surgery on your face; weakness of forehead muscles; trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; have symptoms of a urinary tract infection (UTI) and are being treated for urinary incontinence (symptoms of a urinary tract infection may include pain or burning with urination, frequent urination, or fever); have problems emptying your bladder on your own and are being treated for urinary incontinence; are pregnant or plan to become pregnant (it is not known if BOTOX® can harm your unborn baby); are breastfeeding or plan to (it is not known if BOTOX® passes into breast milk).

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Using BOTOX® with certain medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received BOTOX® in the past.

Tell your doctor if you received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take aspirin-like products or blood thinners.

Other side effects of BOTOX® include: dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, dry eyes, and drooping eyebrows. In people being treated for urinary incontinence other side effects include: urinary tract infection, painful urination, and/or inability to empty your bladder on your own. If you have difficulty fully emptying your bladder after receiving BOTOX®, you may need to use disposable self-catheters to empty your bladder up to a few times each day until your bladder is able to start emptying again.

For more information refer to the Medication Guide or talk with your doctor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see BOTOX® full Product Information including Boxed Warning and Medication Guide.

BOTOX® Savings Program Terms and Conditions

Program Terms, Conditions, and Eligibility Criteria: 1. This offer is good for use only with a valid prescription for BOTOX® (onabotulinumtoxinA). 2. Based on insurance coverage, Chronic Migraine patients can receive up to $700 off per treatment for up to 5 treatments in 2018. The offer is valid for up to $1000 off per treatment for up to 4 treatments received in 2018, for people with Spasticity. The offer is valid for up to $600 off per treatment for up to 4 treatments received in 2018, for people with Cervical Dystonia. The offer is valid for up to $500 off per treatment for up to 4 treatments received in 2018, for people with Overactive Bladder or Overactive Bladder due to a neurologic disease. The offer is valid for up to $150 off per treatment for up to 4 treatments received in 2018, for people with Blepharospasm. The offer is valid for up to $150 off per treatment for up to 4 treatments received in 2018, for people with Strabismus. The offer is valid for up to $100 off per treatment for up to 4 treatments in 2018 for people with severe underarm sweating. All treatments must be received during 2018. Maximum savings limit of $3500 per year for people with Chronic Migraine, $4000 per year for people with Focal Spasticity, $2400 per year for people with Cervical Dystonia, $600 per year for people with Blepharospasm, $600 per year for people with Strabismus, $2000 per year for people with Overactive Bladder or Overactive Bladder due to a neurologic disease, and $400 per year for people with severe underarm sweating applies; patient out-of-pocket expense may vary. 3. This offer is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this offer if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. This offer is not valid for cash-paying patients. 4. This offer is valid for up to 4 or 5 treatments per year, depending on the condition. Offer applies only to treatment received before the program expires on 12/31/18. 5. Offer is valid only for BOTOX® and BOTOX® treatment-related costs not covered by insurance. 6. A BOTOX® Savings Program check will be provided upon approval of a claim. The claim must be submitted with treatment details from an Explanation of Benefits (EOB) or a Specialty Pharmacy Provider (SPP) receipt. (If the BOTOX® prescription was filled by a Specialty Pharmacy Provider, both EOB and SPP details must be provided.) All claims must be submitted within 90 days of the date of EOB receipt. You may be required to provide a copy of your EOB or SPP receipt for your claim to be approved. 7. A BOTOX® Savings Program check may be sent either directly to you or to your selected healthcare provider who provided treatment. For payment to be made directly to your healthcare provider, you must authorize an assignment of benefit during each claim submission. You are not obligated to assign your BOTOX® Savings Program benefit to your healthcare provider to participate in the program. 8. Allergan reserves the right to rescind, revoke, or amend this offer without notice. 9. Offer good only in the USA, including Puerto Rico, at participating retail locations. 10. Void where prohibited by law, taxed, or restricted. 11. This offer is not health insurance. 12. By participating in the BOTOX® Savings Program, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.

For questions about this program, please call 1-800-44-BOTOX.

BOTOX® (onabotulinumtoxinA) Important Information

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Indications
BOTOX® is a prescription medicine that is injected into muscles and used: