BOTOX® Savings Card

The BOTOX® Savings Card

Commercially insured patients can save on out-of-pocket BOTOX® treatment costs.

Covered out-of-pocket costs include your BOTOX® medicine and the injection procedure.

OR
Enrolled in BOTOX® Partnership for Access?
The BOTOX® Partnership for Access Program has changed names to the BOTOX® Savings Card. Get answers to questions you may have about the transition.
Already enrolled? Submit a claim.
Submit a claim form and proof that you received BOTOX® treatment. That's how we know how much savings you will receive. Submitting your forms online is easy!

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Please see below for full Indications, Important Limitations, and Important Safety Information.
IMPORTANT SAFETY INFORMATION
BOTOX® and BOTOX® Cosmetic may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX® or BOTOX® Cosmetic:
  • Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months
  • Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing

There has not been a confirmed serious case of spread of toxin effect away from the injection site when BOTOX® has been used at the recommended dose to treat chronic migraine, severe underarm sweating, blepharospasm, strabismus, or when BOTOX® Cosmetic has been used at the recommended dose to treat frown lines or crow’s feet lines.

BOTOX® and BOTOX® Cosmetic may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of taking BOTOX® and BOTOX® Cosmetic. If this happens, do not drive a car, operate machinery, or do other dangerous activities.

Indications

BOTOX® is a prescription medicine that is injected into muscles and used:

  • to treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency), and urinating often (frequency) in adults 18 years and older when another type of medicine (anticholinergic) does not work well enough or cannot be taken
  • to treat leakage of urine (incontinence) in adults 18 years and older with overactive bladder due to neurologic disease who still have leakage or cannot tolerate the side effects after trying an anticholinergic medication
  • to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years or older
  • to treat increased muscle stiffness in elbow, wrist, finger, and thumb muscles in people 18 years and older with upper limb spasticity
  • to treat increased muscle stiffness in ankle and toe muscles in people 18 years and older with lower limb spasticity
  • to treat the abnormal head position and neck pain that happens with cervical dystonia (CD) in people 16 years and older
  • to treat certain types of eye muscle problems (strabismus) or abnormal spasm of the eyelids (blepharospasm) in people 12 years and older

BOTOX® is also injected into the skin to treat the symptoms of severe underarm sweating (severe primary axillary hyperhidrosis) when medicines used on the skin (topical) do not work well enough in people 18 years and older.

BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults for a short period of time (temporary).

BOTOX® Cosmetic is a prescription medicine that is injected into the area around the side of the eyes to improve the look of moderate to severe crow’s feet lines in adults for a short period of time (temporary).

It is not known whether BOTOX® and BOTOX® Cosmetic are safe or effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine).

It is not known whether BOTOX® is safe or effective to treat increased stiffness in upper limb muscles other than those in the elbow, wrist, fingers, and thumb, or to treat increased stiffness in lower limb muscles other than those in the ankle and toes. BOTOX® has not been shown to help people perform task-specific functions with their upper limbs or increase movement in joints that are permanently fixed in position by stiff muscles. Treatment with BOTOX® is not meant to replace your existing physical therapy or other rehabilitation that your doctor may have prescribed.

It is not known whether BOTOX® and BOTOX® Cosmetic are safe or effective for severe sweating anywhere other than your armpits.

IMPORTANT SAFETY INFORMATION (continued)

Do not take BOTOX® or BOTOX® Cosmetic if you: are allergic to any of the ingredients in BOTOX® (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® (rimabotulinumtoxinB), Dysport® (abobotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have a skin infection at the planned injection site.

Do not take BOTOX® for the treatment of urinary incontinence if you: have a urinary tract infection (UTI) or cannot empty your bladder on your own and are not routinely catheterizing.

Due to the risk of urinary retention (not being able to empty the bladder), only patients who are willing and able to initiate catheterization post-treatment, if required, should be considered for treatment.

Patients treated for overactive bladder
In clinical trials, 36 of the 552 patients had to self-catheterize for urinary retention following treatment with BOTOX® compared to 2 of the 542 treated with placebo.

Patients with diabetes mellitus treated with BOTOX® were more likely to develop urinary retention than non-diabetics.

Patients treated for overactive bladder due to neurologic disease
In clinical trials, 30.6% of patients (33/108) who were not using clean intermittent catheterization (CIC) prior to injection, required catheterization for urinary retention following treatment with BOTOX® 200 Units as compared to 6.7% of patients (7/104) treated with placebo. The median duration of post-injection catheterization for these patients treated with BOTOX® 200 Units (n = 33) was 289 days (minimum 1 day to maximum 530 days) as compared to a median duration 358 days (minimum 2 days to maximum 379 days) for patients receiving placebo (n = 7).

Among patients not using CIC at baseline, those with MS were more likely to require CIC post-injection than those with SCI.

The dose of BOTOX® and BOTOX® Cosmetic is not the same as, or comparable to, any other botulinum toxin product.

Serious and/or immediate allergic reactions have been reported. They include itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Get medical help right away if you experience symptoms; further injection of BOTOX® or BOTOX® Cosmetic should be discontinued.

Tell your doctor about all your muscle or nerve conditions such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including difficulty swallowing and difficulty breathing from typical doses of BOTOX® or BOTOX® Cosmetic.

Tell your doctor if you have any breathing-related problems. Your doctor will want to monitor you for any breathing problems during your treatment with BOTOX® for spasticity or for detrusor overactivity associated with a neurologic condition. The risk of pulmonary effects in patients with compromised respiratory status is increased in patients receiving BOTOX®.

Cornea problems have been reported. Cornea (surface of the eye) problems have been reported in some people receiving BOTOX® for their blepharospasm, especially in people with certain nerve disorders. BOTOX® may cause the eyelids to blink less, which could lead to the surface of the eye being exposed to air more than is usual. Tell your doctor if you experience any problems with your eyes while receiving BOTOX®. Your doctor may treat your eyes with drops, ointments, contact lenses, or with an eye patch.

Bleeding behind the eye has been reported. Bleeding behind the eyeball has been reported in some people receiving BOTOX® for their strabismus. Tell your doctor if you notice any new visual problems while receiving BOTOX®.

Bronchitis and upper respiratory tract infections (common colds) have been reported. Bronchitis was reported more frequently in people receiving BOTOX® for upper limb spasticity. Upper respiratory infections (common colds) were also reported more frequently in people with prior breathing-related problems with upper and lower limb spasticity.

Autonomic dysreflexia in patients treated for overactive bladder due to neurologic disease. Autonomic dysreflexia associated with intradetrusor injections of BOTOX® could occur in patients treated for detrusor overactivity associated with a neurologic condition and may require prompt medical therapy. In clinical trials, the incidence of autonomic dysreflexia was greater in patients treated with BOTOX® 200 Units compared with placebo (1.5% versus 0.4%, respectively).

Tell your doctor about all your medical conditions, including if you: have or have had bleeding problems; have plans to have surgery; had surgery on your face; weakness of forehead muscles; trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; have symptoms of a urinary tract infection (UTI) and are being treated for urinary incontinence (symptoms of a urinary tract infection may include pain or burning with urination, frequent urination, or fever); have problems emptying your bladder on your own and are being treated for urinary incontinence; are pregnant or plan to become pregnant (it is not known if BOTOX® or BOTOX® Cosmetic can harm your unborn baby); are breastfeeding or plan to (it is not known if BOTOX® or BOTOX® Cosmetic passes into breast milk).

Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal products. Using BOTOX® or BOTOX® Cosmetic with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received BOTOX® or BOTOX® Cosmetic in the past.

Tell your doctor if you have received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (tell your doctor exactly which product you received); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take aspirin-like products or blood thinners.

Other side effects of BOTOX® and BOTOX® Cosmetic include: dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, and eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes. In people being treated for urinary incontinence other side effects include: urinary tract infection, painful urination, and/or inability to empty your bladder on your own. If you have difficulty fully emptying your bladder after receiving BOTOX®, you may need to use disposable self-catheters to empty your bladder up to a few times each day until your bladder is able to start emptying again.

For more information refer to the Medication Guide or talk with your doctor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see BOTOX® full Product Information including Boxed Warning and Medication Guide.

Please see BOTOX® Cosmetic full Product Information including Boxed Warning and Medication Guide.

Your BOTOX® Savings Card may only be used at hospitals, physician offices, and pharmacies, and will not be accepted at any other location that normally accepts Visa® Debit cards. The BOTOX® Savings Card cannot be used at merchants outside the United States (including Internet and mail/telephone merchants).

The BOTOX® Savings Card is issued by Metropolitan Commercial Bank, member FDIC, pursuant to license by Visa U.S.A., Inc. “Metropolitan Commercial Bank” and “Metropolitan” are registered trademarks of Metropolitan Commercial Bank ©2014. See the Cardholder Agreement for Terms and Conditions. By accepting, signing, or using this savings card, you agree to the Terms and Conditions of the Cardholder Agreement. This savings card will remain the property of the issuing institution and the privilege of its use may be withdrawn at any time.

Terms and Conditions

By participating, you understand and agree to comply with the Program rules as set forth below.

Your BOTOX® Savings Card provides savings on out-of-pocket costs for BOTOX® (onabotulinumtoxinA) and related procedures. The offer is valid for up to $1000 off 1 treatment received January-March 2016 and up to $500 off per treatment for up to 3 treatments received April-December 2016 for people with upper limb spasticity (elbow, wrist, fingers, thumb)/lower limb spasticity or cervical dystonia; up to $400 off 1 treatment received January-March 2016 and up to $200 off per treatment for up to 4 treatments received April-December 2016 for people with Chronic Migraine; and up to $300 off 1 treatment received January-March 2016 and up to $150 off per treatment for up to 3 treatments received April-December 2016 for people with blepharospasm or strabismus; up to $100 off per treatment for up to 4 treatments for people with hyperhidrosis; up to $500 off treatments occurring between January-June 2016 and up to $300 off treatments occurring between July-December 2016 for people with bladder dysfunction (maximum of $800 in savings per patient per year). All treatments must be received within a 12-month period.

Offer is not valid for any other products or other out-of-pocket costs, even if those costs are associated with the administration of BOTOX® treatment. The BOTOX® Savings Card will be funded upon approval of a claim. The claim must be submitted with an Explanation of Benefits (EOB) or a Specialty Pharmacy Provider (SPP) receipt. (If the BOTOX® prescription was filled by a Specialty Pharmacy Provider, both an EOB and SPP receipt must be sent.)

All claims must be submitted within 90 days of the date of service listed on the EOB. BOTOX® Savings Card may not be combined with any other offer or discount. This BOTOX® Savings Card is not health insurance.

Offer not valid for patients participating in Medicare, Medicaid, or any similar federal or state healthcare program, including any state medical or pharmaceutical assistance programs. If patients are eligible for drug benefits under any such program, they cannot use this BOTOX® Savings Card.

Offer void where prohibited by law, taxed, or restricted. Offer good only in the United States. Allergan reserves the right to rescind, revoke, and amend this offer without notice.

INFORMATION ABOUT THE BOTOX® Partnership for Access Prepaid MasterCard

The BOTOX® Partnership for Access Prepaid MasterCard is valid at participating locations and cannot be used at merchants outside the United States (including Internet and mail/telephone order merchants). This card is issued by MetaBank®, Member FDIC, pursuant to license by MasterCard International Incorporated. BOTOX® is not a product of MetaBank or endorsed by them. At the request of MetaBank, use of this card is authorized for healthcare-related expenses and can be used at physician offices, hospitals, and retail pharmacies only as set forth in your MetaBank card agreement. MasterCard is a registered trademark of MasterCard International Incorporated. Upon confirmation of eligibility in the Partnership for Access Program, you may be asked for additional information to verify your identity in order to have a prepaid card issued to you.

The information on this site is intended for US consumers only. No information on this site is provided with the intention to give medical advice or instructions on the accurate use of Allergan products. Allergan cannot answer unsolicited emails requesting personal medical advice; visitors should always consult a healthcare professional. Please visit the Allergan site for your country of residence for information concerning Allergan products and services available there.

Terms and Conditions

By participating, you understand and agree to comply with the Program rules as set forth below.

Your BOTOX® Savings Card provides savings on out-of-pocket costs for BOTOX® (onabotulinumtoxinA) and related procedures. The offer is valid for up to $1500 off 1 treatment received January-March 2016 and up to $750 off per treatment for up to 3 treatments received April-December 2016 for people with upper limb spasticity (elbow, wrist, fingers, thumb)/lower limb spasticity or cervical dystonia; up to $600 off 1 treatment received January-March 2016 and up to $300 off per treatment for up to 4 treatments received April-December 2016 for people with Chronic Migraine; and up to $400 off 1 treatment received January-March 2016 and up to $200 off per treatment for up to 3 treatments received April-December 2016 for people with blepharospasm or strabismus. All treatments must be received within a 12-month period.

Offer is not valid for any other products or other out-of-pocket costs, even if those costs are associated with the administration of BOTOX® treatment. The BOTOX® Savings Card will be funded upon approval of a claim. The claim must be submitted with an Explanation of Benefits (EOB) or a Specialty Pharmacy Provider (SPP) receipt. (If the BOTOX® prescription was filled by a Specialty Pharmacy Provider, both an EOB and SPP receipt must be sent.)

All claims must be submitted within 90 days of the date of service listed on the EOB. BOTOX® Savings Card may not be combined with any other offer or discount. This BOTOX® Savings Card is not health insurance.

Offer not valid for patients participating in Medicare, Medicaid, or any similar federal or state healthcare program, including any state medical or pharmaceutical assistance programs. If patients are eligible for drug benefits under any such program, they cannot use this BOTOX® Savings Card.

Offer void where prohibited by law, taxed, or restricted. Offer good only in the United States. Allergan reserves the right to rescind, revoke, and amend this offer without notice.

Only valid in pre-specified states.

Reference: 1. BOTOX® Prescribing Information, January 2016.

References: 1. Data on file, Allergan; Q4 2015 CD/ULS Reimbursement Coverage. 2. Data on file, Allergan; January 2013 through December 2014 Patient Out-of-Pocket Cost Analysis.

References: 1. Data on file, Allergan; Q1 2015 CM Reimbursement Coverage. 2. BOTOX® Prescribing Information, January 2016.

Reference: 1. Data on file, Allergan; September 2014 OAB/NDO Reimbursement Coverage.

References: 1. Data on file, Allergan; Q4 2015 CD/ULS Reimbursement Coverage. 2. Data on file, Allergan; January 2013 through December 2014 Patient Out-of-Pocket Cost Analysis.

Reference: 1. BOTOX® Prescribing Information, January 2016.

Reference: 1. Data on file, Allergan; January 2013 through December 2014 Patient Out-of-Pocket Cost Analysis.

Looking for BOTOX® Cosmetic?

BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to temporarily improve the look of both moderate to severe crow's feet lines and frown lines between the eyebrows in adults.

The BOTOX® Savings Card can only be used to cover treatment-related costs for medical uses of BOTOX®. However, you can still save on BOTOX® Cosmetic with the Brilliant Distinctions® Rewards Program.

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Full BOTOX® Cosmetic Product Information including Boxed Warning and
Medication Guide

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