Offer does not constitute health insurance.ġ2. Void where prohibited by law, taxed, or restricted.ġ1. Offer good only in the USA, including Puerto Rico, at participating retail locations.ġ0. Allergan ® reserves the right to rescind, revoke, or amend this offer without notice.ĩ. Assigning your BOTOX ® Savings Program benefit to your healthcare provider is not required to participate in the program.Ĩ. For payment to be made to your healthcare provider, an authorized assignment of benefit also must be included with the Claim. A BOTOX ® Savings Program check will be provided upon approval of a claim and may be sent either directly to you or to your authorized healthcare provider who provided treatment.
Claims must be submitted within 180 days of treatment date and must include a copy of (a) an Explanation of Benefits (EOB) for the BOTOX ® treatment, (b) a Specialty Pharmacy (SP) receipt for BOTOX ®, or (c) other writing showing payment of out-of-pocket BOTOX ® and treatment-related out-of-pocket costs.ħ. For residents of Massachusetts and Rhode Island, offer applies only to the cost of BOTOX ® and not to any related medical service(s).Ħ. Offer valid only for BOTOX ® and BOTOX ® treatment-related costs not covered by insurance.
Offer valid for up to 5 treatments over a 12-month period.ĥ. Offer not valid for (a) patients enrolled in Medicare, Medicaid, TRICARE or any other government-reimbursed healthcare program (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse for the entire cost of prescription drugs (b) patients who are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees (c) cash-paying patients.Ĥ. $1000 per treatment with a maximum savings limit of $4000 per year patient out-of-pocket expense may vary.ģ. Based on insurance coverage, reimbursement may be up to Offer good only with a valid prescription for BOTOX ® (onabotulinumtoxinA).Ģ.
* Program Terms, Conditions, and Eligibility Criteria:ġ.
BOTOX SAVINGS PROGRAM FULL
Please see BOTOX ® Cosmetic full Prescribing Information including Boxed Warning and Medication Guide.īOTOX ® Savings Program Terms and Conditions Data are not a guarantee of coverage, or partial or full payment, by any payers listed.įor information on BOTOX ® Cosmetic (onabotulinumtoxinA) please see. Out-of-pocket costs and insurance plans vary.
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