Esbriet Coverage
Benefits Investigations
Esbriet 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
A BI may be initiated once the SMN and PAN are submitted to Esbriet
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
Esbriet Access Solutions can help you identify if a prior
authorization (PA) is necessary and offer resources as you obtain it
for your patient. PA support may be provided once the SMN and PAN are
submitted to Esbriet Access Solutions.
If your patient’s request for a PA is not granted, your Pulmonology Field Reimbursement Manager (PFRM) or Esbriet Access Solutions Specialist 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.
Esbriet Start Now Program
With the Esbriet Start Now Program, eligible patients taking Esbriet may receive free medicine while awaiting an insurance coverage determination.
If you think your patient qualifies for the Esbriet Start Now
Program, submit the completed SMN and PAN to Esbriet Access
Solutions.
Eligible patients can receive a free supply of Esbriet for up to 30
days. Once coverage has been determined, the patient no longer
qualifies for the Esbriet Start Now Program.
PAN=Patient Authorization and Notice of Request
for Transmission of Health Information to Genentech Access Solutions
and Genentech® Access to Care Foundation.
SMN=Statement of Medical Necessity.