allerganrcc.com ALLERGAN RETINA COVERAGE CONNECTION? Portal

allerganrcc.com
Title: ALLERGAN RETINA COVERAGE CONNECTION? Portal
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Description: ALLERGAN RETINA COVERAGE CONNECTION? Portal Monday, August 01, 2016 FOR U.S. HEALTHCARE PROFESSIONALS ONLY OZURDEX? (dexamethasone intravitreal implant)0.7mg Home Register Now Program Tools Customer
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ALLERGAN RETINA COVERAGE CONNECTION? Portal Monday, August 01, 2016 FOR U.S. HEALTHCARE PROFESSIONALS ONLY OZURDEX? (dexamethasone intravitreal implant)0.7mg Home Register Now Program Tools Customer Support Program Forms Program Resources Email Suggestion User Name Password Please protect the confidentiality of your patients by not revealing or sharing login credentials. Forgot User Name Forgot Password To register for online services, click here: If you are a registered user, please login above. PRESCRIBING INFORMATION OZURDEX?(dexamethasone intravitreal implant)0.7mg Prescribing Information CONTACT US 1-866-OZURDEX 1-866-676-4069 Monday through Friday 9:00 am to 8:00 pm EST ALLERGAN RETINA COVERAGE CONNECTION? P.O. Box 1308 San Bruno, CA 94066 Helpful Links OZURDEX PATIENT ASSISTANCE? Program Application Your Provider Resource Center for Service and Information Relating to OZURDEX? (dexamethasone intravitreal implant) Reimbursement Click here to see Important Information about OZURDEX? (dexamethasone intravitreal implant)0.7mg Welcome to the ALLERGAN RETINA COVERAGE CONNECTION? Portal REIMBURSEMENT SUPPORT SERVICES Discover the many programs Allergan has created to make the OZURDEX? (dexamethasone intravitreal implant) Reimbursement process easier for you. Insurance Verification (IV) Simply submit a request for an Insurance Verification and a hotline Reimbursement Counselor will contact the payer to verify coverage status for OZURDEX? (dexamethasone intravitreal implant) treatment, check Medical & Pharmacy benefits including co-pay and deductible (if applicable). This service is available to registered Provider Homepage users. Reimbursement Forms Download many useful forms, including sample CMS 1500, UB-04, Letter of Medical Necessity and many others. Reimbursement Information Access helpful information about OZURDEX? best practices concerning the reimbursement process, denied claims, appeals and more. PROVIDER HOMEPAGE Register to gain access to many valuable features and services. Immediate access to all your active OZURDEX? patients - regardless of when you started using the provider website - with real-time patient status. Pre-population of active patient information and current physician information. OZURDEX PATIENT ASSISTANCE? Program This program provides OZURDEX? at no charge to financially eligible patients. Those who may qualify include patients who are uninsured or underinsured. Allergan is proud to assist eligible uninsured and underinsured patients with their treatment through the donation of OZURDEX?. User Acknowledgement TERMS OF USE Welcome to Lash Group Provider Portal (the "Site"), a website for services arranged by The Lash Group, Inc. ("Lash") and administered and operated by The Lash Group, Inc. ("Lash"). The Site contains information about Alpha drug, a product of Lash. Access to and use of the Site are subject to the following terms and conditions and all applicable laws (collectively, "Terms of Use"). If you do not agree with the Terms of Use, please do not use the Site. As the Terms of Use may be revised from time to time, you should review them periodically. Furthermore, by using the Site you agree to execute any and all documents that are necessary to make use of the Site, and the services offered through the Site, available to you. By using the Site, you are indicating that you are at least eighteen (18) years old and have the legal authority to accept the Terms of Use. This is a legally binding agreement. Services The Site performs certain services exclusively for those providers who use the Alpha drug, by serving to electronically verify insurance eligibility status of the Alpha drug with payers. The Site does not route or store any information related to other non-Alpha drug related insurance eligibility or other services beyond what is needed to extract the Alpha drug-related information from data submitted by the provider and to perform the services offered through the Site. Access to Password-Protected Areas Portions of the Site are password-protected ("Password Protected Areas"). To be eligible to access the Password Protected Areas, you must be a physician or staff member of a physician office that has received a login and password information from the Site. The login and password are for your personal use only and are not transferable. You may not share your login or password with any other individual. You agree that you will be responsible for maintaining your password as confidential and for any activity that occurs as a result of your enabling or permitting another person or entity to use your password. You agree to immediately notify Lash by one of the methods listed in these Terms of Use in the event that (i) your password is lost or stolen, or (ii) you become aware of any unauthorized use of your password or of any other breach of security related to the Password-Protected Areas. Lash is not responsible for any loss or damage arising from your failure to comply with the provisions of this section. Compliance with Laws You may not use the Site for any purpose or in any manner that violates any local, state, or federal law or regulation or the law or regulation of any foreign government. You represent and warrant that you have all rights to post and/or submit any data or information through the Site (collectively, "Data"). You agree that you will only submit Data in compliance with the Health Information Portability and Accountability Act of 1996 ("HIPAA") and other applicable state or federal privacy laws. You agree that, to the extent required and/or appropriate, you are responsible for obtaining any authorizations, informed consents, and/or other required approvals prior to submitting Data to the Site, and, upon Lash's request, you agree to present redacted copies of the same to Lash. Prohibited Behavior You are responsible for all Data that you upload, post, email or otherwise transmit using the Site. You agree not to use the Site to: Upload, post, email, or otherwise transmit any Data that infringes any patent, trademark, trade secret, copyright or other intellectual property right, privacy right, or publicity right of any person or entity; Directly or indirectly, intentionally disrupt or interfere with the Site or services in any manner that may materially adversely affect Lash or any third party; or Upload, post, email or otherwise transmit any material that contains software viruses or any other code, files or programs designed or known to disable, interrupt, or limit the functionality of any computer hardware, computer software, or telecommunications equipment or facilities.Limitations The use of the Site does NOT promise or guarantee coverage, payment or reimbursement, in whole or in part, of any Alpha drug claim by a payer or other third parties. You agree that you accept responsibility for all applicable Alpha drug claims and for your use of the Site. Please consult your payer organization with regard to local or actual coverage and reimbursement policies and determination processes for the Alpha drug. Copyrights You should assume that all contents of the Site are copyrighted unless otherwise noted and may not be used except as provided herein and without the express written permission of Lash. Except as expressly provided above, nothing contained herein shall be construed as conferring any license or right under any Lash copyright. Trademarks All product names, logos, and service marks displayed on the Site that are identified by r or T or appearing in type form different from that of the surrounding text (collectively, the "Trademarks") are registered or unregistered trademarks owned by or licensed to Lash or our affiliates, unless otherwise identified as being owned by another entity. Nothing contained herein shall be construed as conferring by implication, estoppel, or otherwise any license or right, either express or implied, under any patent or Trademark of Lash or any third party. No use of any Trademark may be made without the prior written authorization of Lash, except to identify the product or services of the company. User Responsibility Each person assumes full responsibility and all risks arising from use of the Site. IN NO EVENT SHALL ANY OF LASH, OUR RESPECTIVE AFFILIATES, AND ANY OF OUR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, REPRESENTATIVES, INFORMATION PROVIDERS, AND LICENSORS AND THEIR RESPECTIVE HEIRS AND ASSIGNS, BE LIABLE FOR ANY DAMAGES OF ANY KIND OR NATURE, INCLUDING, BUT NOT LIMITED TO, DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL, EXEMPLARY, SPECIAL (INCLUDING LOSS OF PROFIT), PUNITIVE, OR OTHER DAMAGES ARISING FROM OR IN CONNECTION WITH THE EXISTENCE OR USE OF THE SITE, REGARDLESS OF WHETHER LASH OR ANY OF THE OTHER ENTITIES OR PERSONS LISTED ABOVE HAS BEEN ADVISED AS TO THE POSSIBILITY OF SUCH DAMAGES. This includes damages to, or for viruses that may infect, your computer equipment. Without limiting the foregoing, everything on the Site is provided to you "AS IS" AND "AS AVAILABLE" BASIS, AND LASH MAKE NO REPRESENTATIONS OR WARRANTIES OF ANY KIND OR NATURE WITH RESPECT TO THE SITE. LASH HEREBY DISCLAIM ALL REPRESENTATIONS AND WARRANTIES, WHETHER EXPRESS OR IMPLIED, CREATED BY LAW, CONTRACT OR OTHERWISE, INCLUDING, BUT NOT LIMITED TO, ANY WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, OR NON-INFRINGEMENT. LASH MAKE NO WARRANTY THAT THE SITE WILL MEET YOUR REQUIREMENTS, OR WILL BE UNINTERRUPTED, TIMELY, SECURE, CURRENT, ACCURATE, COMPLETE OR ERROR-FREE OR THAT THE RESULTS THAT MAY BE OBTAINED BY USE OF THE SITE WILL BE ACCURATE OR RELIABLE. IN ADDITION, NEITHER LASH MAKE ANY WARRANTY WITH RESPECT TO THE INTEROPERABILITY OF ANY SYSTEM WITH THE SITE, INCLUDING, WITHOUT LIMITATION, ANY SYSTEM USED BY YOU OR ANY PAYER, WHETHER PROVIDED BY A THIRD PARTY LICENSOR OR OTHERWISE. Please note that some jurisdictions may not allow the exclusion of implied warranties, so some of the above exclusions may not apply to you. Check your local laws for any restrictions or limitations regarding the exclusion of implied warranties. YOU UNDERSTAND AND ACKNOWLEDGE THAT YOUR SOLE AND EXCLUSIVE REMEDY WITH RESPECT TO ANY DEFECT IN OR DISSATISFACTION WITH THE SITE IS TO CEASE TO USE THE SITE. YOU MAY HAVE OTHER RIGHTS WHICH MAY VARY FROM STATE TO STATE. Medical Advice No information in the Site is provided with the intention to give medical advice or instructions on the accurate use of Lash products. Lash cannot answer e-mails or other correspondence requesting personal medical advice. HIPAA Compliance All services through the Site are provided by Lash (or other third parties through Lash). To the extent you are a covered entity under HIPAA and provide Protected Health Information ("PHI"), as defined under HIPAA, to Lash to perform requested services through the Site, Lash may be considered a business associate of you and the following terms are applicable: All capitalized terms used in this section of these Terms of Use have the meanings ascribed to them in HIPAA. With regard to its use and/or disclosure of PHI, Lash agrees to: not use or disclose PHI other than as permitted or required by these Terms of Use or as otherwise required or permitted by law; use appropriate safeguards to prevent use or disclosure of PHI other than as provided for by these Terms of Use; report in writing to you any use or disclosure of PHI not provided for by these Terms of Use of which Lash's management becomes aware within ten (10) business days of Lash's knowledge of an unauthorized use or disclosure; mitigate, to the extent practicable, any harmful effect that is known to Lash of a use or disclosure of PHI by Lash in violation of the requirements of these Terms of Use; require all of its subcontractors and agents that receive or use, or have access to, PHI, to agree, in writing, to essentially the same restrictions and conditions on the use and/or disclosure of PHI that apply to Lash pursuant to this section of the Terms of Use; make available PHI necessary for you to respond to individuals' requests for access to PHI about them in the event that the PHI in Lash's possession constitutes a Designated Record Set. Lash shall provide you with the PHI within a reasonable time from the date of the request; make available PHI for amendment within a reasonable time of receipt of a written request and incorporate any amendments to the PHI within ten (10) business days in accordance with the Privacy Rule of HIPAA in the event that the PHI in Lash's possession constitutes a Designated Record Set; provide you with an accounting of disclosures for individual in the form required by 45 C.F.R. 164.528 within a reasonable time of your request; make its internal practices, books and records relating to the use and disclosure of PHI available to you and the Secretary of HHS or designee for purposes of determining your compliance with the Privacy Rule; and return to you or destroy, within ninety (90) days of the termination of these Terms of Use, the PHI in its possession as a result of these Terms of Use and retain no copies, if it is feasible to do so. If return or destruction is infeasible, Lash agrees to extend all protections contained in this section of the Terms of Use to Lash's use and/or disclosure of any retained PHI, and to limit any further uses and/or disclosures to the purposes that make the return or destruction of the PHI infeasible.With respect to Electronic PHI ("EPHI") that you permit Lash to create, receive, maintain, or transmit, Lash agrees to: Implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the EPHI that Lash creates, receives, maintains, or transmits on your behalf; Ensure that any agent, including a subcontractor, to whom Lash provides such EPHI, agrees to implement reasonable and appropriate safeguards to protect it; Report any Security Incident of which Lash become aware; provided, that trivial attempts to penetrate Lash's systems that occur on a daily basis such as scans, "pings" or other unsuccessful attempts to penetrate computer networks or systems maintained by Lash, will not be reported; and Authorize termination of these Terms of Use by you, if you determine that Lash has violated a material term of this section of the Terms of Use and if Lash Group has failed to cure the violation within thirty (30) days of written notice from you.Except as otherwise specified in these Terms of Use, Lash may make any and all uses and disclosures of PHI necessary to perform its obligations under these Terms of Use. Unless otherwise limited herein, Lash may: (a) use the PHI in its possession for its proper management and administration and to carry out the legal responsibilities of Lash; (b) disclose the PHI in its possession to a third party for the purpose of Lash's proper management and administration or to carry out the legal responsibilities of Lash, provided that the disclosures are required by law or Lash obtains reasonable assurances from the third party regarding the confidential handling of such PHI as required under the Privacy Rule; (c) provide Data Aggregation services relating to your health care operations; and (d) de-identify (in accordance with the de-identification requirements of the Privacy Rule) any and all PHI obtained by Lash under these Terms of Use, and use and disclose such de-identified data, as permitted by law. You shall notify Lash, in writing, of any arrangements between you and an individual that is the subject of PHI that may impact in any manner the use and/or disclosure of that PHI by Lash under this Agreement. You may immediately terminate these Terms of Use if you determine that Lash has breached a material term of these Terms of Use and if Lash Group has failed to cure the violation within thirty (30) days of written notice from you. If Lash commits a material breach of its obligations; Lash did not take reasonable steps to cure the breach or end the violation or the steps were unsuccessful; and termination of this Agreement is not feasible, then you may report the breach to the Secretary of HHS. Personal information Lash respect your right and your patients' right to privacy of their personally identifiable information and feel it is important for you to know how the information received from you via the Site is collected and used. Personally identifiable information is information that could be used to identify a specific person, including you or your patient. The personally identifiable information that is collected through the Site includes, but is not limited to, the name, address, phone number, fax number, and National Provider Identifier number of physicians who use the Site; and the name, address, Social Security number, date of birth, phone number, insurance and other medical information of patients. This Site collects personally identifiable information (including patient's Protected Health Information as defined under HIPAA) and uses and discloses it to perform the services described in these Terms of Use, all in compliance with applicable federal and state laws, including HIPAA and its privacy and security provisions.In addition, Lash and any of our affiliates may use and disclose your information in order to contact you, via e-mail, regular mail, telephone or other means: to respond to and facilitate your requests for information (e.g., about the Site, the Alpha drug), to provide you with additional information about products or services (of ours and of others) that may be of interest to you, to obtain your feedback for analytical purposes in order to research, develop and improve programs, products, services and content, to protect our rights under these Terms of Use, to protect the health, safety or welfare of someone, or to comply with any applicable law or regulation, court order or other legal process. Lash shall not directly or indirectly sell, loan, trade, or lease any PHI obtained through the Site with any third parties. With regard to PHI, the Site will employ appropriate administrative, physical, technical, and managerial procedures to safeguard and secure the information collected, consistent with industry practices and the sensitivity of the information provided. Although Lash make a genuine effort to ensure the security of such information and the transactions conducted on the Site, including employing appropriate encryption technology, Lash can not guarantee the security of the information, nor can Lash guarantee that information you supply will not be intercepted while being transmitted via the Site. You acknowledge this and that system failures may limit your ability to use the Site. You agree to assume all risk and liability arising from your use of the Site, including the risk posed by any breach in the security of communications and transactions you conduct through the Site. Lash may have access to PHI received from you and other authorized users of the Site only if that information has been de-identified in a manner consistent with HIPAA's applicable privacy and security provisions or if such access is otherwise permitted or required by law. Access to personally identifiable information is limited only to those Lash employees or representatives, and other third-party vendors and partners, who have a business need to know, all of whom are required to keep your information confidential. Except with respect to PHI, any communication or material that you transmit to, or post on, the Site by electronic mail or otherwise, including any data, questions, comments, suggestions, or the like, is, and will be treated as, nonconfidential and nonproprietary information, and Lash shall not have any obligation of any kind with respect to such information. Lash and any of our affiliates may use such information for any purpose whatsoever, including, but not limited to, reproduction, disclosure, transmission, publication, broadcast, and further posting. Further, Lash and any of our affiliates shall be free to use such information, including, but not limited to, any ideas, concepts, know-how, or techniques contained therein, for any purpose whatsoever, including, but not limited to, researching, developing, manufacturing, and marketing products incorporating such information. Non-identifiable Data and How We Use It This Site also collects non-identifiable data including web logs, pages visited, operating systems, and web browser type (Windows, Safari, Mozilla, Safari, etc.) and version. This Site also uses cookies when you visit to help recognize and track non-personal information, including your internet service provider. The log information cookies do not collect any personal information. Countries The Site and its contents are intended for use by licensed physicians (and their staff) within the United States. This Web site may contain links to other Web sites. Lash is not responsible for and does not control the contents or performance of such Web sites, and accepts no responsibility for the consequences of your use thereof. Indemnity You agree to indemnify and hold Lash, other third party service providers, and our respective affiliates, officers, directors, employees and agents harmless from and against any third party claim, action or demand and all liabilities and settlements related thereto, including without limitation, reasonable legal and accounting fees (including defense costs), resulting from, or alleged to result from, a breach of these Terms of Use or your use of the Site or its services. Forward-Looking Statements The Site may contain information that is forward-looking and involve risks and uncertainties, including, without limitation, risks and uncertainties of research and development, clinical development, regulatory approvals, our reliance on third-party manufacturers, product commercialization, competition, patents, product liability, and third-party reimbursement, and other risks and uncertainties detailed from time to time in Lash's periodic reports filed with the Securities and Exchange Commission. Actual results may differ from the forward-looking information. Miscellaneous The Terms of Use constitute the entire agreement between you and Lash relating to the Site. There is no agency, partnership or joint venture relationship between any user and Lash arising solely through the use of the Site. The Terms of Use are binding upon your successors, assigns, heirs and executors. If any provision of the Terms of Use is found to be invalid by any court having competent jurisdiction, the invalidity of such provision shall not affect the validity of the remaining provisions of the Terms and Conditions, which shall remain in full force and effect. The failure of any party to exercise or enforce any right or provision of the Terms of Use shall not constitute a waiver of such right or condition. Any claim or cause of action arising out of or related to the Site or the Terms of Use must be filed within one year after such claim or cause of action arose. The section titles of the Terms of Use are merely for convenience and will not have any effect on the substantive meaning of this Agreement. IMPORTANT SAFETY INFORMATION The Alpha drug is not right for you if: Indications and Usage Retinal Vein Occlusion OZURDEX? (dexamethasone intravitreal implant) is a corticosteroid indicated for the treatment of macular edema following branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Posterior Segment Uveitis OZURDEX? is indicated for the treatment of noninfectious uveitis affecting the posterior segment of the eye. Diabetic Macular Edema OZURDEX? (dexamethasone intravitreal implant) is a corticosteroid indicated for the treatment of diabetic macular edema. Dosage and Administration FOR OPHTHALMIC INTRAVITREAL INJECTION. The intravitreal injection procedure should be carried out under controlled aseptic conditions. Following the intravitreal injection, patients should be monitored for elevation in intraocular pressure and for endophthalmitis. Patients should be instructed to report any symptoms suggestive of endophthalmitis without delay. IMPORTANT SAFETY INFORMATION Contraindications Ocular or Periocular Infections: OZURDEX? (dexamethasone intravitreal implant) is contraindicated in patients with active or suspected ocular or periocular infections including most viral diseases of the cornea and conjunctiva, including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, and fungal diseases. Glaucoma: OZURDEX? is contraindicated in patients with glaucoma, who have cup to disc ratios of greater than 0.8. Torn or Ruptured Posterior Lens Capsule: OZURDEX? is contraindicated in patients whose posterior lens capsule is torn or ruptured because of the risk of migration into the anterior chamber. Laser posterior capsulotomy in pseudophakic patients is not a contraindication for OZURDEX? use. Hypersensitivity: OZURDEX? is contraindicated in patients with known hypersensitivity to any components of this product. Warnings and Precautions Intravitreal Injection-related Effects: Intravitreal injections, including those with OZURDEX?, have been associated with endophthalmitis, eye inflammation, increased intraocular pressure, and retinal detachments. Patients should be monitored regularly following the injection. Steroid-related Effects: Use of corticosteroids including OZURDEX? may produce posterior subcapsular cataracts, increased intraocular pressure, glaucoma, and may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses. Corticosteroids should be used cautiously in patients with a history of ocular herpes simplex because of the potential for reactivation of the viral infection. Adverse Reactions Retinal Vein Occlusion and Posterior Segment Uveitis Adverse reactions reported by greater than 2% of patients in the first 6 months following injection of OZURDEX? for retinal vein occlusion and posterior segment uveitis include: intraocular pressure increased (25%), conjunctival hemorrhage (22%), eye pain (8%), conjunctival hyperemia (7%), ocular hypertension (5%), cataract (5%), vitreous detachment (2%), and headache (4%). Increased IOP with OZURDEX? peaked at approximately week 8. During the initial treatment period, 1% (3/421) of the patients who received OZURDEX? required surgical procedures for management of elevated IOP. Diabetic Macular Edema Ocular adverse reactions reported by greater than or equal to 1% of patients in the two combined 3-year clinical trials following injection of OZURDEX? for diabetic macular edema include: cataract (68%), conjunctival hemorrhage (23%), visual acuity reduced (9%), conjunctivitis (6%), vitreous floaters (5%), conjunctival edema (5%), dry eye (5%), vitreous detachment (4%), vitreous opacities (3%), retinal aneurysm (3%), foreign body sensation (2%), corneal erosion (2%), keratitis (2%), anterior chamber inflammation (2%), retinal tear (2%), eyelid ptosis (2%). Non-ocular adverse reactions reported by greater than or equal to 5% of patients include: hypertension (13%) and bronchitis (5%). Increased Intraocular Pressure: IOP elevation greater than or equal to 10 mm Hg from baseline at any visit was seen in 28% of OZURDEX? patients versus 4% of sham patients. 42% of the patients who received OZURDEX? were subsequently treated with IOP-lowering medications during the study versus 10% of sham patients. The increase in mean IOP was seen with each treatment cycle, and the mean IOP generally returned to baseline between treatment cycles (at the end of the 6-month period). Cataracts and Cataract Surgery: The incidence of cataract development in patients who had a phakic study eye was higher in the OZURDEX? group (68%) compared with Sham (21%). The median time of cataract being reported as an adverse event was approximately 15 months in the OZURDEX? group and 12 months in the Sham group. Among these patients, 61% of OZURDEX? subjects versus 8% of sham-controlled subjects underwent cataract surgery, generally between Month 18 and Month 39 (Median Month 21 for OZURDEX? group and 20 for Sham) of the studies. Please click here for the full Prescribing Information. ?2014 Allergan, Inc. ? and ? Marks owned by Allergan, Inc. Terms Of Use Privacy Site Map Last updated on June 2016 Processing... The information on this site is intended for US residents only. No information in this site is provided with the intention to give medical advice or instructions on the accurate use of Allergan products. Allergan cannot answer unsolicited e-mails requesting personal medical advice; visitors should always consult a healthcare professional. APC13HX16

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