Back To TOP

Benefits Investigation

 

Why is a benefits investigation important?

 

Erivedge Access Solutions conducts Benefits Investigation (BI) to help you better understand your patient's health plan coverage for some or all of the costs associated with Erivedge® (vismodegib) treatment. The BI can also determine if a prior authorization or patient assistance might be needed.

 

To have Erivedge Access Solutions conduct a BI, all you need to do is request our assistance on the signed Statement of Medical Necessity (SMN) form.

 

 

 

There are 3 possible outcomes of a BI:

  • Treatment is covered
  • Prior Authorization is required
  • Treatment is denied

 

To begin with Erivedge Access Solutions, you must complete and submit the SMN and have your patient complete and submit a Patient Authorization and Notice of Release of Information (PAN) form.

 

The SMN can be submitted online via My Patient Solutions™ or downloaded from Forms and Documents.

Patients can access the PAN through Forms and Documents.

 

This description of a BI is for informational purposes only. The completion and submission of a BI are the responsibility of the patient and your office. Erivedge Access Solutions makes no representation or guarantee concerning reimbursement or coverage for any service or item.

 

Prior Authorization

 

Erivedge Access Solutions can help your practice identify whether a prior authorization (PA) is needed and help you in the process of securing it. All we need to begin are a completed and signed SMN form requesting our assistance with the PA as well as a signed and dated PAN form.

 

 

 

 

Erivedge Access Solutions can help you as you submit the required PA forms and documentation. If the PA is not granted, Erivedge Access Solutions can work with you to determine your next steps. Tips like this can be found in Forms and Documents.

 

Erivedge Sure Start

With the Erivedge Sure Start Program, the patient can begin receiving free treatment while awaiting a coverage determination.

 

Erivedge Sure Start Program Eligibility

A patient should be eligible for the Erivedge Sure Start Program if the following conditions are met:

 

  • Patient is taking Erivedge for a labeled indication
  • Your patient has not received the initial benefits investigation (BI) or prior authorization (PA) decision for Erivedge within 7 days
  • Your patient has not received a coverage decision within 7 days from Erivedge Access Solutions receipt of the SMN form

 

Patients who are not eligible for the Erivedge Sure Start Program include:

 

  • A patient who is not insured
  • A patient whose health plan does not require a Prior Authorization (PA)

 

If your patient qualifies for the Erivedge Sure Start Program, submit completed SMN and PAN forms to Erivedge Access Solutions.

 

 

Eligible patients can receive a 14-day supply of Erivedge for up to 6 refills. Once coverage has been determined, the patient no longer qualifies for the Erivedge Sure Start Program.

Learn More About
Erivedge
  • LEARN about treatment with Erivedge
  • FIND the right patient assistance program with our Compass for Patient Access tool
  • LEARN HOW the Genentech BioOncology Co-pay Card can help with the out-of-pocket costs for Erivedge
  • Download: new forms for enrollment in GATCF

 

 

 

 

 

 

 

  • Form Statement of Medical Necessity
  • Form Statement of Medical Necessity for Dermatologists, Mohs Surgeons and Other Specialties
  • Form Patient Authorization and Notice of Release of Information

The Access Solutions logo is a registered trademark of Genentech, Inc.