Why is a benefits investigation important?
Tarceva 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 needed.
There are 3 possible outcomes of a BI:
- Treatment is covered
- PA is required
- Treatment is denied
To begin with Tarceva 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. Tarceva Access Solutions makes no representation or guarantee concerning reimbursement or coverage for any service or item.
Tarceva 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.
Tarceva Access Solutions can help you as you submit the required PA forms and documentation. If the PA is not granted, Tarceva Access Solutions can work with you to determine your next steps. Tips like this can be found in Forms and Documents.
With the SureStart Program, eligible patients may receive treatment while awaiting an insurance coverage determination.
SureStart Program Eligibility
A patient should be eligible for the SureStart Program if the following conditions are met:
- Patient is taking Tarceva for an approved indication
- Patient has not received a coverage decision within 7 days
If you think your patient qualifies for the Tarceva SureStart Program, submit completed SMN and PAN forms to Tarceva Access Solutions.
Eligible patients can receive a 15-day shipment of Tarceva for up to 3 months. Once coverage has been determined, the patient no longer qualifies for the SureStart Program.