Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

AccessPlus Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Alimera Sciences, Inc.

c/o RxCrossroads
PO Box 5873
Louisville, KY 40205

TEL: 844-445-8843, opt. 3


FAX: 844-501-7161
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

AccessPlus Patient Assistance Program Enrollment Form: Contact program

Let Us Help: Your Guide to Financial Assistance Options for Iluvien Brochure

 

Brand Name Medications Covered

 
  • Iluvien implant
 

Generic Name

 
  • fluocinolone acetonide implant
 

Eligibility Requirements   

Insurance Status Uninsured or Underinsured with no prescription coverage for needed medication
Those with Part D Eligible? No
Income At or below 500% of FPL
Diagnosis/Medical Criteria *See Additional Information section below
US Residency Required? United States or Puerto Rico
   

Application

Obtaining The Doctor should call for an application or download it from the website
Receiving Downloaded from website
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Not specified
   

Medication

Amount/Supply As prescribed by Doctor
Sent To Doctor's office or specific site
Delivery Time Not specified
Refill Process No Refills
Limit Not specified
Re-application Not applicable
   

Additional Information

* for the treatment of diabetic macular edema in patients who have been treated with corticosteroids before and did not have a significant increase in eye pressure.

Contact program for more details: www.iluvien.com.com

This program also provides co-pay and reimbursement assistance.


Updated September 27, 2018