Why is a benefits investigation important?
Esbriet Access Solutions conducts a benefits investigation (BI) to
help you better understand your patient's health insurance plan
coverage for the costs associated with treatment. The BI can also
determine if a prior authorization (PA) or patient assistance might be
There are 3 possible outcomes of a BI:
- Treatment is covered
- PA is required
- Treatment is denied
To begin with Esbriet Access Solutions, you must complete and submit a Statement of Medical Necessity (SMN) form and have your patient complete and submit a Patient Authorization and Notice of Release of Information (PAN) form. To request a BI, be sure to check the appropriate box on the SMN.
This description of a BI is for informational purposes only.
Esbriet Access Solutions makes no representation or guarantee
concerning reimbursement or coverage for any service or item.
Esbriet Access Solutions can help your practice identify if a prior
authorization (PA) is needed and offer support as you obtain it for
your patient. All we need to begin are a completed and signed
Statement of Medical Necessity (SMN) form requesting our assistance
with the PA as well as a signed and dated Patient Authorization and
Notice of Release of Information (PAN) form.
Esbriet Access Solutions can help you as you submit the required PA forms and documentation. If the PA is not granted, Esbriet Access Solutions can work with you to determine your next steps. Tips like this can be found in Forms and Documents.
Esbriet Start Now Program
The Esbriet Start Now Program helps patients who have experienced an insurance coverage delay get started on therapy.
The Esbriet Start Now Program provides a free supply of Esbriet for up to 30 days for eligible patients still waiting for their insurance plans’ coverage decision. To get started, complete the Esbriet Start Now Program section of the Statement of Medical Necessity (SMN) form, remembering to check the box next to the Esbriet Start Now Program Prescription.
Esbriet Start Now Program Eligibility
To be eligible for the Esbriet Start Now Program, patients must:
- Have a prescription for Esbriet for an approved indication
- Be insured and have experienced a delay of at least 7 days in receiving a coverage decision for Esbriet
- Be new Esbriet patients or patients who have not taken Esbriet in the past 12 months
If you think your patient qualifies for the Esbriet Start Now Program, submit a completed SMN and PAN forms to Esbriet Access Solutions.
Terms and Conditions
The Esbriet Start Now Program provides eligible patients who have experienced an insurance coverage delay with a one-time free supply of Esbriet 267 mg. There is no purchase of obligation by virtue of a patient’s receipt of the free supply. Requests for the Esbriet Start Now Program cannot be processed without a completed and signed 1) Esbriet Statement of Medical Necessity and 2) Patient Authorization and Notice of Release of Information. Patients must be prescribed Esbriet for an on-label use. Free product via the Esbriet Start Now Program will be available through Esbriet Access Solutions. Neither the prescriber, the pharmacies, nor any patients receiving free product via the Esbriet Start Now Program may seek reimbursement or credit for all or any part of the benefit received by the patient through this offer from any insurer, health plan, or government program. The Esbriet Start Now Program cannot be counted towards any out-of-pocket costs under any plan (such as true out-of-pocket cost [TrOOP] under a Medicare Part D prescription drug plan). Esbriet Access Solutions may notify the patient’s insurer that the patient is receiving a free supply of product from the Program. Prescribers may not advertise or otherwise use the program as a means of promoting their services or Genentech’s products to patients. This program is void where prohibited by law and may not be used in or by residents of restricted states, if applicable. The free supply may not be sold, purchased or traded or offered for sale, purchase or trade. This program is not a benefit plan. Genentech reserves the right to discontinue or modify the terms of this program at any time, without notice.