iLink® Copay Savings Program

Are you living with keratoconus? Get up to $200 towards your copay expenses.

This program is intended to support patients treated with the FDA-approved corneal cross-linking procedure which can slow or halt the progression of keratoconus.

Enroll and receive up to $200* towards your non-reimbursable expenses.

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Eligibility

This program is open to anyone with commercial insurance coverage. As is typical of co-pay programs, those who are a government beneficiary and/or participant in a federal or state-funded health insurance program (eg, Medicare, Medicare Advantage, Medigap, Medicaid, VA, DoD, TRICARE) are not eligible, as mandated by government guidelines.

Applies to procedures completed between December 1, 2021 and December 31, 2022.

Enrollment

Take the following steps to enroll in the program:

  • Download and fill out the application to enroll in the iLink® Copay Savings Program. The form will need to be completed, signed, and faxed to the number provided.
  • Make an appointment with your doctor performing the FDA approved corneal collagen cross-linking procedure with Photrexa® drug formulations [Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa® (riboflavin 5’-phosphate ophthalmic solution)] and the KXL® System or locate a doctor near you by using the LivingwithKC.com doctor locator.
  • If your doctor determines you need the corneal cross-linking procedure with Photrexa® drug formulations, the iLink® Copay Savings Program will cover your non-reimbursable out of pocket copay expenses up to $200*.
  • Submit via fax your Explanation of Benefits from your commercial insurance provider related to the corneal cross-linking procedure with Photrexa® drug formulations after you have the procedure.
  • All successful copay applications will receive reimbursement in the form of a check to the mailing address provided.

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The iLink® Copay Savings Program (The Program) is sponsored by Glaukos. Glaukos’s mission is to transform the treatment of chronic eye diseases with novel therapies that provide sustainable solutions to important clinical needs.

*The iLink® Copay Savings Program covers copays related to the performance of the FDA approved corneal cross-linking procedure with Photrexa® drug formulations up to $200. The maximum payment under the program is $200.

Applies to procedures completed between December 1, 2021 and December 31, 2022.

The patient or their guardian must be 18 years or older for the patient to be eligible. This Program is only valid in the United States and U.S. Territories. This Program is void where prohibited by law. This offer cannot be combined with other offers. Not valid for copays that are not related to the FDA approved corneal cross-linking procedure with Photrexa® drug formulations [Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa® (riboflavin 5’-phosphate ophthalmic solution)] and the KXL® System that slows or halts the progression of keratoconus. Receipts must clearly state that the copays were for the corneal cross-linking procedure with Photrexa® drug formulations.

The Explanation of Benefits (EOB) Form you receive from your insurance provider should show both the professional fee and pharmaceutical fee associated with your procedure. Legally, the copay voucher can only apply to your out of pocket expenses related to the pharmaceutical fee. Your EOB form should show J2787 and 0402T. The J code is for the Photrexa drug formulations. Your copay related to this code will be eligible for reimbursement. The T code is related to your physician’s time during the procedure and is not eligible for reimbursement as part of this program.

Using Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa® (riboflavin 5’-phosphate ophthalmic solution), and the KXL® System, the iLink® corneal cross-linking procedure from Glaukos is the only FDA-approved therapeutic treatment for patients with progressive keratoconus and corneal ectasia following refractive surgery.*1

[Photrexa IFU/p1/col1/para3/lines1-4]

Indications

Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate ophthalmic solution) are indicated for use with the KXL System in corneal collagen cross-linking for the treatment of progressive keratoconus and corneal ectasia following refractive surgery.

Important Safety Information

Corneal collagen cross-linking should not be performed on pregnant women.

Ulcerative keratitis can occur. Patients should be monitored for resolution of epithelial defects. The most common ocular adverse reaction was corneal opacity (haze). Other ocular side effects include punctate keratitis, corneal striae, dry eye, corneal epithelium defect, eye pain, light sensitivity, reduced visual acuity, and blurred vision.

These are not all the side effects of the corneal collagen cross-linking treatment. For more information, go www.livingwithkeratoconus.com to obtain the FDA-approved product labeling.

You are encouraged to report all side effects to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

*Photrexa® Viscous and Photrexa® are manufactured for Avedro. The KXL® System is manufactured by Avedro. Avedro is a wholly owned subsidiary of Glaukos Corporation.

Reference

1. Photrexa Prescribing Information. Waltham, MA: Glaukos, Inc. 2018