Download the Patient Questionnaire for more information.
Download the Patient Copay Program Brochure for more information.
Patients who:
Your healthcare provider can enroll you OR you can call 1-888-461-2255, Option 3, to enroll.
Terms and Conditions for Patients
1. This offer is valid for commercially-insured patients only and is good for use only with a MYOBLOC prescription at the time the prescription is filled or after the product is administered to the patient. 2. Depending on insurance coverage, eligible, insured patients may pay no more than zero dollars ($0) for MYOBLOC and the administrative services associated with MYOBLOC, up to a maximum savings limit of four thousand dollars ($4,000) per year. Patient out-of-pocket expense may vary. 3. This offer is not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs, or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this Program if they are Medicare-eligible and enrolled in an employer-sponsored health plan or medical or prescription drug benefit program for retirees. 4. The offer is valid for one (1) year. 5. US WorldMeds reserves the right to rescind, revoke, or amend this offer without notice. 6. Offer good only in the USA, including Puerto Rico, at participating pharmacies or healthcare providers. 7. Void if prohibited by law, taxed, or restricted. 8. Residents of Michigan, Rhode Island, and Minnesota are not eligible for assistance with payment for injection or injection guidance-related costs, but may receive assistance with MYOBLOC. 9. This Program is not transferable. The selling, purchasing, trading, or counterfeiting of this Program is prohibited by law. 10. This Program is not insurance. 11. By redeeming this assistance, you represent that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.
MYOBLOC is a prescription medicine to reduce saliva in adults and is used to treat chronic sialorrhea (drooling).
MYOBLOC can cause serious side effects, including allergic reactions. Symptoms of an allergic reaction to MYOBLOC may include: itching, rash, redness, swelling, wheezing, trouble breathing, or dizziness or feeling faint. Tell your doctor or get medical help right away if you get wheezing, or trouble breathing, or if you get dizzy or faint.
The most common side effects of MYOBLOC in people with sialorrhea include dry mouth and trouble swallowing (dysphagia).
These are not all the possible side effects of MYOBLOC. Please see the full Important Safety Information.
Do not receive MYOBLOC if you:
Sialorrhea, more commonly known as drooling, is the medical term for an excess spillage of saliva from the mouth. It is a common symptom in certain neurodegenerative diseases, such as Parkinson’s disease (PD).1 Chronic sialorrhea is when you’ve experienced this drooling for at least 3 months.
Sialorrhea can make many aspects of daily life more challenging and can also have physical consequences.
In many patients with sialorrhea, their neurodegenerative disease, such as PD, makes it hard to swallow. The saliva builds up in the mouth, which leads to drooling.
The MYOBLOC Copay Program may be able to help. The Copay Program helps eligible chronic sialorrhea patients with out-of-pocket expenses for MYOBLOC. Learn more about the MYOBLOC Copay Program here.
MYOBLOC is available at no charge to patients approved for the Patient Assistance Program.
Qualification criteria:
To learn more call 1-888-461-2255, Option 3.
REFERENCES:
MYOBLOC® (rimabotulinumtoxinB) injection is indicated for:
MYOBLOC® may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems anytime (hours to weeks) after treatment with MYOBLOC:
MYOBLOC is a prescription medicine used in adults that is injected into:
Do not receive MYOBLOC if you: are allergic to MYOBLOC or any of its ingredients (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as BOTOX® or BOTOX® Cosmetic, DYSPORT®, or XEOMIN®; have a skin infection at the planned injection site.
Tell your doctor about all your medical conditions, including if you have: a disease that affects your muscles or nerves (such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome); had any side effect from any botulinum toxin product in the past; a breathing problem, such as asthma or emphysema; a history of swallowing problems or aspiration; bleeding problems; drooping eyelids; plans to have surgery; had surgery on your face.
Tell your doctor if you: are pregnant or plan to become pregnant (it is not known if MYOBLOC can harm your unborn baby); are breastfeeding or plan to breastfeed (it is not known if MYOBLOC passes into breast milk).
Tell your doctor about all medicines you take, including: prescription and over-the-counter medicines, vitamins, and herbal supplements. Using MYOBLOC 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 MYOBLOC in the past.
Especially tell your doctor if you: received any other botulinum toxin product in the last 4 months; received injections of botulinum toxin such as BOTOX® or BOTOX® Cosmetic, DYSPORT®, or XEOMIN® in the past (tell your doctor exactly which product you received); recently received an antibiotic injection; take muscle relaxants; take allergy or cold medicines; take sleep medicine.
MYOBLOC can cause serious side effects, including allergic reactions. Symptoms of allergic reaction may include: itching, rash, redness, swelling, wheezing, trouble breathing, or dizziness or feeling faint. Tell your doctor or get medical help right away if you get wheezing, or trouble breathing, or if you get dizzy or faint.
Other side effects of MYOBLOC include:
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.
MYOBLOC is a registered trademark of Solstice Neurosciences, LLC,
a wholly-owned subsidiary of US WorldMeds, LLC.
© 2019. US WorldMeds, LLC USWMMYO-00067 11/19
MYOBLOC® (rimabotulinumtoxinB) injection is indicated for:
MYOBLOC® may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems anytime (hours to weeks) after treatment with MYOBLOC:
MYOBLOC is a prescription medicine used in adults that is injected into:
Do not receive MYOBLOC if you: are allergic to MYOBLOC or any of its ingredients (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as BOTOX® or BOTOX® Cosmetic, DYSPORT®, or XEOMIN®; have a skin infection at the planned injection site.
Tell your doctor about all your medical conditions, including if you have: a disease that affects your muscles or nerves (such as ALS or Lou Gehrig’s disease, myasthenia gravis, or Lambert-Eaton syndrome); had any side effect from any botulinum toxin product in the past; a breathing problem, such as asthma or emphysema; a history of swallowing problems or aspiration; bleeding problems; drooping eyelids; plans to have surgery; had surgery on your face.
Tell your doctor if you: are pregnant or plan to become pregnant (it is not known if MYOBLOC can harm your unborn baby); are breastfeeding or plan to breastfeed (it is not known if MYOBLOC passes into breast milk).
Tell your doctor about all medicines you take, including: prescription and over-the-counter medicines, vitamins, and herbal supplements. Using MYOBLOC 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 MYOBLOC in the past.
Especially tell your doctor if you: received any other botulinum toxin product in the last 4 months; received injections of botulinum toxin such as BOTOX® or BOTOX® Cosmetic, DYSPORT®, or XEOMIN® in the past (tell your doctor exactly which product you received); recently received an antibiotic injection; take muscle relaxants; take allergy or cold medicines; take sleep medicine.
MYOBLOC can cause serious side effects, including allergic reactions. Symptoms of allergic reaction may include: itching, rash, redness, swelling, wheezing, trouble breathing, or dizziness or feeling faint. Tell your doctor or get medical help right away if you get wheezing, or trouble breathing, or if you get dizzy or faint.
Other side effects of MYOBLOC include:
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.
MYOBLOC is a registered trademark of Solstice Neurosciences, LLC,
a wholly-owned subsidiary of US WorldMeds, LLC.
© 2019. US WorldMeds, LLC USWMMYO-00067 11/19
