The Patient Assistance Program provides XEOMIN at no cost to those who qualify*

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Enroll now to determine eligibility to participate in the XEOMIN Patient Assistance Program

Merz is proud to offer XEOMIN vials at no cost to those who qualify. Enroll now to check eligibility.

Download Enrollment
Form

XEOMIN is available at no charge to eligible* patients who:

  • Are uninsured or underinsured
  • Meet financial eligibility requirements (based on the Federal Poverty Guidelines)
    • Proof of income is required
    • Eligibility will be determined prior to the first injection for both uninsured and underinsured patients
  • Are US residents
  • Are not enrolled in Medicare, Medicaid, or any other government program
  • Meet specific medical and clinical guidelines as determined by Merz
  • Eligibility must be re-established every 12 months

If you are underinsured, there are certain steps your doctor must follow before you can receive XEOMIN at no charge. Talk to your doctor if you have any questions.

*Criteria for the XEOMIN Patient Assistance Program are established by Merz North America, Inc. and/or its affiliate, Merz Pharmaceuticals, LLC. Acceptance into the XEOMIN Patient Assistance Program does not entitle patients to receive assistance indefinitely. Eligibility must be re-established every 12 months, and assistance under the XEOMIN Patient Assistance Program may be terminated at any time. Please see the application for additional required eligibility information.

For assistance, call 1-844-4MYMERZ (1-844-469-6379) to reach a MERZ CONNECT specialist Monday through Friday between 8am–8pm ET.