New Rebate Program – Q4 2021

PROGRAM DURATION: October 1 – December 31, 2021

Minimum Qualifying Purchases Required for Tiered Rebate Payment
TIER
INSERTS PURCHASED
REBATE PER INSERT*
1
10
$20
2
50
$30
3
125
$40
4
250
$50
5
500+
$70

* Insert = 1 DEXTENZA intracanalicular insert

Terms

  • All purchasing Ambulatory Surgical Centers, Hospital Outpatient Departments, and other healthcare provider entities are eligible to participate in the DEXTENZA Rebate Program.
  • Rebates under this program are not available to multisite customers under contract with Ocular Therapeutix. If you are a multisite customer, please email  ecg@ocutx.com for more information.
  • Customer remittance details and W-9 tax form are required by calendar quarter-end of the initial applicable quarter in which customer is participating. Remittance form and W-9 tax form may be submitted to: oculrebates@ocutx.com.
  • Rebate payments are only available on qualified purchases based on customer’s servicing distributor’s invoice date for shipments made between October 1 to December 31, 2021. Payments will be made within 60 days after calendar quarter end.
  • This rebate program is not related to any other rebate program for DEXTENZA.
  • Rebates under the program are not available to customers receiving any discounts or rebates for DEXTENZA through any other source.
  • Inserts purchased under 340B program are excluded.
  • Rebates made available under the DEXTENZA Rebate Program represent discounts that must be properly and accurately accounted for, disclosed and reported by purchasers on cost reports or claims for reimbursement to federal healthcare programs (including Medicare and Medicaid) and other third party payor programs requiring such disclosure, and to federal and state agencies upon request, in accordance with all applicable laws and regulations.

PURCHASE OPTIONS

Contact one of our authorized distributors listed below to order DEXTENZA and receive it by the next business day.

Distributor Info
Phone
Fax
Website
Besse Medical
1-800-543-2111
1-800-543-8695
Cardinal Specialty
Pharma Distribution
1-855-855-0708
1-614-553-6301
FFF Enterprises
1-800-843-7477
1-800-418-4333
Metro Medical
1-800-768-2002
1-615-256-4194
McKesson
Medical-Surgical
1-855-571-2100
1-800-311-3408
McKesson Plasma &
Biologics for Hospitals
1-877-625-2566
1-888-752-7626
McKesson
Specialty Health
1-855-477-9800
1-800-800-5673

Ocular Therapeutix does not recommend the use of any particular distributor.

Product
Active Ingredient
Size
NDC #
DEXTENZA
(dexamethasone ophthalmic insert) 0.4 mg
(dexamethasone USP)
1's
70382-0204-01
DEXTENZA
(dexamethasone ophthalmic insert) 0.4 mg
(dexamethasone USP)
10's
70382-0204-10

For further purchase inquiries, please contact your distributor or Ocular Therapeutix

Customer Service: 1-888-315-7906
Monday – Friday 9 AM – 6 PM ET

Billing and Coding

Available Codes for DEXTENZA

J-code

J1096

DEXTENZA
CPT® Code

0356T

DEXTENZA Administration
CPT Modifiers

RT/LT

Right Eye/Left Eye
NDC Number

70382-0204-01,
70382-0204-10

1-insert carton,
10-insert carton

How is a pass-through product coded and billed?

  • A unique J-code (J1096) allows ASCs and HOPDs to bill Medicare and other payers for DEXTENZA
  • The payment is in addition to facility fees paid to ASCs or HOPDs for cataract surgery

No effect on physician fees

  • Payment to surgeons for cataract surgery under Medicare’s Physician Fee Schedule will not be affected by the pass-through payment status of DEXTENZA

No effect on the healthcare system

  • Pass-through regulation is budget-neutral to the healthcare system
  • If surgeons and/or facilities do not access pass-through payments, the allotted funds will be used by other specialties and any remaining amounts will be lost

DEXTENZA360™ provides comprehensive support for obtaining benefits verification and determining the appropriate codes preferred by the payer.

Coverage and reimbursement may vary by payer, contractual agreements, and site of service. Customers are responsible for determining the appropriate coding and submission of accurate claims. Ocular Therapeutix does not guarantee reimbursement or payment of claims.

Work with your DEXTENZA Field Reimbursement Manager to determine billable status for your payers and identify which plans allow for separate payment of drugs, new technologies, and pass-through drugs.

For billing, certain payers may require the 10-digit NDC to be converted to 11 digits.

CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

ASC = ambulatory surgical center; HOPD = Hospital Outpatient Department; CPT = Current Procedural Terminology;

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full Prescribing Information
IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS
DEXTENZA is contraindicated in patients with active corneal, conjunctival or canalicular infections, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella; mycobacterial infections; fungal diseases of the eye, and dacryocystitis.

WARNINGS AND PRECAUTIONS
Intraocular Pressure Increase – Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. Steroids should be used with caution in the presence of glaucoma. Intraocular pressure should be monitored during treatment.

Bacterial Infections – Corticosteroids may suppress the host response and thus increase the hazard for secondary ocular infections. In acute purulent conditions, steroids may mask infection and enhance existing infection.

Viral Infections – Use of ocular steroids may prolong the course and may exacerbate the severity of many viral infections of the eye (including herpes simplex).

Fungal Infections – Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use. Fungal culture should be taken when appropriate.

Delayed Healing – Use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation.

ADVERSE REACTIONS
Ocular Inflammation and Pain Following Ophthalmic Surgery
The most common ocular adverse reactions that occurred in patients treated with DEXTENZA were: anterior chamber inflammation including iritis and iridocyclitis (10%), intraocular pressure increased (6%), visual acuity reduced (2%), cystoid macular edema (1%), corneal edema (1%), eye pain (1%), and conjunctival hyperemia (1%). The most common non-ocular adverse reaction was headache (1%).

Itching Associated with Allergic Conjunctivitis
The most common ocular adverse reactions that occurred in patients treated with DEXTENZA were: intraocular pressure increased (3%), lacrimation increased (1%), eye discharge (1%), and visual acuity reduced (1%). The most common non-ocular adverse reaction was headache (1%).

INDICATIONS

DEXTENZA is a corticosteroid indicated for:

  • The treatment of ocular inflammation and pain following ophthalmic surgery.
  • The treatment of ocular itching associated with allergic conjunctivitis.

New Indication

DEXTENZA is now approved for the treatment of ocular itching associated with allergic conjunctivitis.

Learn more

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