ENSPRYNG Coverage

Benefits Investigations

ENSPRYNG Access Solutions can conduct a benefits investigation (BI) to help you determine if a Genentech medicine is covered, if prior authorizations (PAs) are required, which specialty pharmacy (SP) the health insurance plan prefers and if patient assistance might be needed.

Potential outcomes of a BI:

  • Treatment is covered
  • PA is required
  • Treatment is denied

Once the BI is complete, your Patient Navigator will walk your patient through his or her insurance coverage for ENSPRYNG.

A BI may be initiated once the ENSPRYNG Start Form is submitted to ENSPRYNG Access Solutions.

These can be downloaded from Forms and Documents or submitted online via My Patient Solutions

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.

Prior Authorization

Your ENSPRYNG Patient Navigator can help you identify if a prior authorization (PA) is necessary and offer resources as you obtain it for your patient. Once your practice has submitted a PA, your Patient Navigator can follow up with the payer regarding the PA status. Remember, submitting the PA is the responsibility of the practice. PA support may be provided once the ENSPRYNG Start Form is submitted to ENSPRYNG Access Solutions.

If your patient’s request for a PA is not granted, your Clinical Reimbursement Manager (CRM) or Patient Navigator can work with you to determine your next steps. You can find more tips like this in Forms and Documents.

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.