![]() Expanded benefit resets at beginning of each calendar year.If your financial responsibility for the medication is greater than the maximum benefit per injection, you will be responsible for any remaining costs not covered by the copay assistance benefit dollars.Following the first two injections of SUBLOCADE in the same calendar year, you will receive a maximum copay assistance amount of $800 per injection for the remainder of the calendar year.The expanded benefit amount is up to $1920.50 for SUBLOCADE. You will receive an expanded benefit amount for the first two injections in the calendar year.You may pay as little as $0 per injection of SUBLOCADE throughout the eligibility period.įollowing your initial enrollment in the Program, and each subsequent calendar year you remain on SUBLOCADE and continue to meet the Program eligibility criteria, you will receive the following medication copay assistance:.You may receive benefits for valid claims submitted with a date of service that is up to 90 days prior to the initial enrollment date, and up to 30 days prior to the re-enrollment date.As a result, your first enrollment period may be up to 15 months, and any subsequent enrollment periods will be one calendar year. If your initial enrollment into the INSUPPORT Copay Assistance Program is between October 1st and December 31st, you will not have to re-enroll in the program at the beginning of the subsequent calendar year. ![]() The eligibility period for the Copay Assistance Program is based on calendar year (January-December). Required to be provided each calendar year to continue receiving benefits, assuming all eligibility criteria continues to be met.Valid for two years from the date of signature.Patient Authorization is required for INSUPPORT to enroll an eligible individual in the INSUPPORT Copay Assistance Program. You may opt-out of these notifications at any time by contacting INSUPPORT. Copay member information may be provided to you via mail, email address, or mobile phone number for patients who opt-in to text communications, provided during the enrollment/re-enrollment processes.Enrollment information that is modified or does not contain the information required will not be accepted by INSUPPORT for evaluation of Program eligibility.You must request eligibility determination and enrollment for the Copay Assistance Program via the INSUPPORT Patient Enrollment Form or.The INSUPPORT Copay Assistance Program is not insurance.You have been prescribed SUBLOCADE by your treatment provider.Your private insurance has not prohibited coupons/copay assistance for SUBLOCADE.You are a resident of a state where copay assistance is not prohibited.You are a resident of the United States or U.S.The Copay Assistance Program is available to individuals only for "on-label" use.You are at least 18 years of age and less than 65 years of age.Individuals with government insurance are not eligible for the Copay Assistance Program, including, but not limited to Medicare, Medicaid, Medigap, VA, DOD, TriCare, CHAMPVA or any other federally or state-funded government-assisted program.The Copay Assistance Program is not valid for uninsured individuals. You must have private health insurance that provides coverage for some portion of the cost of SUBLOCADE under a medical or pharmacy benefit plan. ![]() To receive benefits under the INSUPPORT Copay Assistance Program, you must be determined as eligible and be enrolled in the Copay Assistance Program.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |