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.
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.
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.
|Q:||How long does it take to establish coverage for Erivedge?|
|A:||Several factors affect when and where patients may receive treatment. The time it takes to assess a PA varies among plans. In most cases, it takes 15 to 45 days to establish coverage. In some cases, a PA is not needed.|
|Q:||If the prior authorization is approved, what is the approval duration?|
|A:||Approval lengths can vary among health plans. Contact the plan to determine the duration of the authorization. Be aware of deadlines, since some can be as early as one month after the approval date.|
With the Erivedge Sure Start Program, the patient can begin receiving free treatment while awaiting a coverage determination.
A patient should be eligible for the Erivedge Sure Start Program if the following conditions are met:
Patients who are not eligible for the Erivedge Sure Start Program include:
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.