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HOPD Payment Schedule

Select the latest Addendum B payment schedule for current HOPD payment information

ASC Payment Schedule

Select the latest quarterly ASC payment rate Addendum BB file for current ASC payment information

Payment Schedules

Patient Brochure

Provide your patients with information to help answer their questions about OMIDRIA

OMIDRIA Patient Brochure

Patient Education

Product Monograph

Review this comprehensive clinical guide on OMIDRIA

Product Monograph
Real-World Evidence

Learn about real-world evidence studies associated with OMIDRIA

Real-World Evidence

Clinical Data

For more information, please contact a Rayner Sales Representative.
Ordering Information Sheet

See wholesaler/distributor and billing information for OMIDRIA

Ordering Information Sheet
Procedure Guide

Learn how to store, prepare, and administer OMIDRIA

Procedure Guide

Ordering and Using OMIDRIA

For more information, please contact a Rayner Sales Representative.
Reimbursement Guide

Review this important office guide for coding and billing assistance, including sample claim forms

Reimbursement Guide
We Pay the Difference Fact Sheet

Review this guide for an overview on how to complete the enrollment process for each commercially insured We Pay the Difference patient

We Pay the Difference Fact Sheet
We Pay the Difference Enrollment Form

Enroll commercially insured patients in the We Pay the Difference reimbursement program

We_Pay_the_Difference_Enrollment-_Form_2024.jpg
OMIDRIAssure Patient Certification Form

Determine patient eligibility for the Equal Access patient assistance program

OMIDRIAssure Patient Certification Form
Letter of Medical Necessity

Use this template letter to communicate with payers; this letter can be customized to establish the medical reason that OMIDRIA was used

Letter of Medical Necessity
Letter of Appeal

Use this template letter to communicate with payers; this letter can be customized to appeal a payer’s decision not to reimburse the use of OMIDRIA

Letter of Appeal

Reimbursement Assistance

For more information, please contact an OMIDRIA Field Reimbursement Manager.

DISCOVER RESOURCES & SUPPORT

View or download resources for you, your practice, ASC, or patients

ASC=ambulatory surgery center; HOPD=hospital outpatient department.

Indications and Usage

OMIDRIA® is added to ophthalmic irrigating solution used during cataract surgery or intraocular lens replacement and is indicated for maintaining pupil size by preventing intraoperative miosis and reducing postoperative ocular pain.

Important Safety Information

OMIDRIA must be added to irrigating solution prior to intraocular use.

OMIDRIA is contraindicated in patients with a known hypersensitivity to any of its ingredients.
Systemic exposure to phenylephrine may cause elevations in blood pressure.
Use OMIDRIA with caution in individuals who have previously exhibited sensitivities to acetylsalicylic acid, phenylacetic acid derivatives, and other nonsteroidal anti-inflammatory drugs (NSAIDs), or have a past medical history of asthma.
The most commonly reported adverse reactions at ≥ 2% are eye irritation, posterior capsule opacification, increased intraocular pressure, and anterior chamber inflammation.
Please see the Full Prescribing Information for OMIDRIA.
You are encouraged to report Suspected Adverse Reactions to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Indications and Usage

OMIDRIA® is added to ophthalmic irrigating solution used during cataract surgery or intraocular lens replacement and is indicated for maintaining pupil size by preventing intraoperative miosis and reducing postoperative ocular pain.

Important Safety Information

OMIDRIA must be added to irrigating solution prior to intraocular use.

OMIDRIA is contraindicated in patients with a known hypersensitivity to any of its ingredients.
Systemic exposure to phenylephrine may cause elevations in blood pressure.
Use OMIDRIA with caution in individuals who have previously exhibited sensitivities to acetylsalicylic acid, phenylacetic acid derivatives, and other nonsteroidal anti-inflammatory drugs (NSAIDs), or have a past medical history of asthma.
The most commonly reported adverse reactions at ≥ 2% are eye irritation, posterior capsule opacification, increased intraocular pressure, and anterior chamber inflammation.
Please see the Full Prescribing Information for OMIDRIA.
You are encouraged to report Suspected Adverse Reactions to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

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