2013 Patient Assistance and Reimbursement Guide - Association of ...

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Bristol-Myers Squibb 42 Assistance for Uninsured Patients For patients without prescription drug insurance, Access Support can refer them to independent charitable foundations that may be able to provide financial support, including, the Bristol-Myers Squibb Patient Assistance Foundation, a charitable organization that provides mediwww.bms.com Oncology-related products: Erbitux ® (cetuximab), Ixempra ® (ixabepilone), Sprycel ® (dasatinib), Yervoy ® (ipilimumab) Patient Assistance and Reimbursement Website www.bmsaccesssupport.com PATIENT ASSISTANCE Access Support Access Support offers patient assistance support, benefits investigation, prior authorization support, and appeals assistance. Program counselors are available Monday through Friday, from 8:00 am to 8:00 pm EST at 1.800.861.0048. Access Support can help identify financial assistance programs for patients who need help managing the cost of treatment. The appropriate program will depend on the patient’s coverage: ●● For patients with commercial insurance, product-specific co-pay programs may be available ●● ●● For patients with federally-funded insurance, co-pay support from independent foundations may be available For patients with no insurance, product donations from the BMS Patient Assistance Program may be available. BMS Oncology Co-Pay Program for Yervoy This program is designed to assist with out-of-pocket co-payment or co-insurance requirements for eligible, commercially insured patients who have been prescribed certain BMS products, per the FDA-approved indications. Patients with federally-funded insurance plans are not eligible for this co-pay program. Enrolled patients pay the first $50 of their co-pay per infusion. BMS will cover the remaining amount up to $5,000 per year. If patient out-ofpocket expenses exceed $5,000 per year, the patient is responsible for 5% of the remaining out-of-pocket expenses. BMS will then pay 95% of the remaining outof-pocket expenses. BMS will contribute a maximum of $25,000 per year, per patient. Patient must have an annual household income of less than or equal to $100,000 to qualify for the program. Other restrictions may apply. Final determination of program eligibility is based upon review of completed application. In order to enroll a patient in the BMS Oncology Co-Pay Program, the following information is required: ●● ●● ●● ●● ●● Name Address Insurance carrier Member ID Your office identification number. To enroll a patient, complete the application form (www.bmsaccesssupport.com/ PublishingImages/YERVOY-Enrollment- Form.pdf) and fax it to Access Support at 1.888.776.2370. Southern Ohio Medical Center Cancer Services, Ohio cine, free of charge, to eligible, uninsured patients who have an established financial hardship. The Bristol-Myers Squibb Patient Assistance Foundation accepts the Access Support application. Patients may be eligible for assistance through the Bristol-Myers Squibb Patient Assistance Foundation if they: ●● ●● ●● ●● ●● ●● Do not have public or private insurance that helps to pay for their prescription medications. If the patient is enrolled in Medicare Part D, call the Bristol-Myers Squibb Patient Assistance Foundation, Inc. for more information. The number is 1.800.736.0003. Have a yearly income of less than ~250% of the Federal Poverty Level: ✔ ✔ $27,925 or less for a single person ✔ ✔ $37,825 or less for a family size of two ✔✔ Larger family sizes are adjusted accordingly ✔✔ Medications that are injected may be subject to higher limits. Are being treated with Bristol-Myers Squibb medications. Live in the United States, Puerto Rico, or the US Virgin Islands. Are being treated by a doctor or other healthcare provider who is licensed in the US. Are being treated as an outpatient. These are just some of the eligibility requirements. Other eligibility criteria may apply. For more information about eligibility, call the Bristol-Myers Squibb Patient Assistance Foundation, at 1.800.736.0003. To enroll a patient, complete the appropriate application form below and fax it to Access Support at 1.888.776.2370. ●● ●● ●● ●● Erbitux: www.bmsaccesssupport. com/PublishingImages/ERBITUX- Enrollment-Form.pdf Ixempra: www.bmsaccesssupport. com/PublishingImages/IXEMPRA- Enrollment-Form.pdf Sprycel: www.bmsaccesssupport. com/docs/SPRYCEL-Enrollment- Form.pdf Yervoy: www.bmsaccesssupport.com/ PublishingImages/YERVOY-Enrollment-Form.pdf Assistance for Patients with Federally-Funded Insurance Plans Patients with federally-funded insur- ACCC 2013 Patient Assistance and Reimbursement Guide
BMS Prior Authorization Algorithm STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 STEP 6 Step 1: Verify Patient Coverage. Is your patient insured Yes. No. Step 2: Benefits Investigation. Step 3: Is Prior Authorization Required Yes. No. If prior authorization is not needed, click next to continue. Step 4: Was Prior Authorization Received Yes. No. Step 5: You Now Have Payer Authorization. Step 6: Claim Approved and Patient Received Medication. Yes. No. ance plans are not eligible for co-pay assistance programs sponsored by Bristol-Myers Squibb. However, there are independent foundations that can help. Access Support can refer providers to the foundation offering the best support for their specific patient and help them through the application process. It is important to note that these foundations are independent and not affiliated with Bristol-Myers Squibb. Each foundation has its own eligibility criteria and evaluation process. Bristol-Myers Squibb cannot guarantee that a patient will receive assistance. Reimbursement Assistance Access Support: Benefits Investigation Bristol-Myers Squibb Oncology is committed to helping appropriate patients get access to our medications by providing reimbursement support services for healthcare professionals. After a treatment decision has been made by a healthcare professional, work with Access Support as early as possible, so each case can be tracked through all required steps for coverage and your eligible patients can benefit from all programs we have available. Our Access Support counselors are assigned to specific geographies to enable continuity of support and deeper understanding of the local environment. Each time you call, you will speak to a specialist who is familiar with your office, the details of your patients’ cases, and the insurers in your area. With signed authorization from a patient, Access Support can investigate the patient’s coverage and benefits for Bristol-Myers Squibb products under federally-funded health plans. Access Support can also help identify potential or additional sources of coverage, such as Medicaid, Veterans’ Affairs, or Low Income Subsidy for Medicare Part D enrollees. To initiate the benefits investigation process, access the appropriate enrollment form below. Type in your information and save it to your desktop. Once the form is completed, fax it to: 1.888.776.2370 and confirm receipt of the fax by calling: 1.800.861.0048. ●● ●● ●● ●● Erbitux: www.bmsaccesssupport. com/PublishingImages/ERBITUX- Enrollment-Form.pdf Ixempra: www.bmsaccesssupport. com/PublishingImages/IXEMPRA- Enrollment-Form.pdf Sprycel: www.bmsaccesssupport. com/docs/SPRYCEL-Enrollment- Form.pdf Yervoy: www.bmsaccesssupport.com/ PublishingImages/YERVOY-Enrollment-Form.pdf. Access Support: Prior Authorization Assistance Access Support can help physicians obtain a prior authorization form when one is required by the patient’s health plan. See the algorithm above to see an example process flow that serves as an aid to understanding the reimbursement and appeals processes. To receive prior authorization assistance from Access Support you will need: ●● ●● ●● ●● ●● Patient demographics Complete insurance information and copy of card Physician demographics and signature Diagnosis Drug. Access Support: Appeals Assistance Access Support can assist in navigating the appeals process. However, the preparation and submission of documents to support the appeal is the responsibility of the patient and/or healthcare provider. Providers and patients can appeal an insurer’s decision to deny coverage for an item or service. Some claims may be denied coverage due to the evolving nature of many drug therapies. Use the information below as a reminder when filing an appeal: 1. Coverage decisions may be made by an insurer before the treatment is rendered or after a claim is filed. Coverage decisions that are made before a treatment regimen is initiated are often referred to as “prior authorizations” or “coverage determinations.” 2. Medicare Part B and many other health insurers will not make a coverage decision regarding individual patients before a claim is filed; coverage is considered only at the time a claim is presented for payment. 3. The billing provider can usually appeal an insurer’s decision to deny coverage for a claim. Appeals are almost always subject to timeliness requirements; the window of time allowed for a provider to appeal an unfavorable coverage decision usually begins on the date a claim was adjudicated (processed) by the insurer. 4. If the health insurer approves an appeal, you will be notified and the claim will be reconsidered. If the health insurer denies the appeal, contact Access Support for further assistance at the Support Center by going to: www.bmsaccesssupport.com and clicking on the “Support Center” tab. 43 ACCC 2013 Patient Assistance and Reimbursement Guide
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