PATIENT ASSISTANCE
PROGRAM

INTRODUCING THE XHANCE

PATIENT ASSISTANCE PROGRAM

Through this program, patients who meet certain income and other eligibility requirements may be eligible to receive XHANCE for free for up to six months. Please see below for more detailed information, including how to apply for the program.

ELIGIBILITY AND REQUIREMENTS

What does my income have to be in order to qualify for this program?
At or below 200% of the Federal Poverty Level guidelines.

Is US residency required to qualify?
Yes, patients must be legal US citizens and reside in one of the 50 US states, the District of Columbia, or Puerto Rico.

Am I eligible if I have Medicare coverage?
Yes, unless your Medicare plan includes prescription drug coverage (Part D).

Eligibility for the XHANCE Patient Assistance Program is subject to approval by the XHANCE Patient Program Administrator. Submitting an application to the XHANCE Patient Assistance Program does not guarantee program approval. The XHANCE Patient Assistance Program can be changed, rescinded or revoked at any time without prior notice.

APPLICATION INFORMATION

How do I apply?
Download and complete the application form. Call 855-204-2410 if you need assistance.

How do I submit the application?
The completed application can be submitted by fax (800-784-9950), mail (XHANCE Patient Assistance, 2325 Heritage Center Drive, Furlong, PA 18925), email (optinosepap@msmpatientservices.com), or over the phone (855-204-2410).

How will I know if I am approved?
Patients will be notified directly, by phone or mail, at the phone number or address indicated on the program application.

How long will the approval process take?
Patients will typically be notified of approval/denial within one week after the application is received and determined to be complete.

OptiNose US, Inc. understands that your privacy is important. By providing your name, address, and other requested information, you are giving OptiNose US, Inc., and other parties working with us, permission to communicate with you about XHANCE or other products, services, and offers from OptiNose US, Inc. We will not sell your name or other personal information to any party for its marketing use. Click here to view the privacy policy.

MEDICATION DETAILS

How much medication can I receive?
Approved patients will receive up to six months of XHANCE. Medication will be shipped in three month intervals.

Where will I receive my medication?
Patients will receive their medication at the address provided on the application.

How long will it take for me to receive my medication?
Patients usually will receive their medication within 3-7 business days after approval.

What is the refill process?
Contact 855-204-2410 when you are in need of a refill.

How long will I qualify for this program if I am approved?
Once approved, patients will receive up to six months of XHANCE and then patients would be required to reapply.

IMPORTANT SAFETY INFORMATION

SEE MORE +

INDICATION
XHANCE is a prescription medicine used to treat nasal polyps in adults.

IMPORTANT SAFETY INFORMATION
Do not use XHANCE if you are allergic to fluticasone propionate or any of the ingredients in XHANCE.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. It is very important to tell your healthcare provider if you take antifungal or anti-HIV medicines.

XHANCE can cause nasal problems such as nosebleeds, crusting in the nose, sores (ulcers) in the nose, hole in the cartilage of the nose (nasal septal perforation).

Call your healthcare provider right away or get emergency medical care if you get any of these signs of a serious allergic reaction: rash, hives, swelling of your face, mouth, and tongue, breathing problems, and low blood pressure.

XHANCE can weaken your immune system, make you more likely to get infections, and can make certain infections worse. Avoid contact with people who have a contagious disease such as chickenpox or measles while using XHANCE. If you come in contact with someone who has chickenpox or measles, call your healthcare provider right away.

XHANCE can cause reduced production of steroid hormones by your adrenal gland, resulting in tiredness, weakness, nausea and vomiting, and low blood pressure.

XHANCE can weaken bones (osteoporosis).

The most common side effects of XHANCE include nosebleeds, thrush (fungal infection in the nose and throat), sores (ulcers) in the nose, pain or swelling of the nose or throat (nasopharyngitis), redness of the nose, nasal congestion, sinus infection, slow wound healing and headache.

Before using XHANCE, carefully read the FDA-approved Patient Information and Instructions for Use.

Please see Instructions for Use, Patient Information and full Prescribing Information.