Here is our recommendation based on your selections
The Service Center will verify your patient's insurance coverage. Upon completion, the Service Center will send you a Statement of Benefit with the outcome.
Based on the results, the Service Center will determine if patients with commercial insurance qualify for our Bridge Program while pursuing coverage.
To qualify, patients must have commercial insurance, a valid prescription for LEQVIO®, and either a prior authorization pending for greater than 3 days with the insurance company or a denial of insurance coverage based on a prior authorization request. Patients are eligible for 2 (two) doses of LEQVIO under the Bridge Program.*
In addition, if uninsured or underinsured patients have expressed financial hardship, the Service Center can help connect them with the Novartis Patient Assistance Foundation to determine eligibility.
Prior authorization and appeals support
If your patient's coverage requires prior authorization or if a prior authorization is denied, the Service Center can provide education and resources.
Please note: While we can pre-populate patient demographic information on the required forms, we cannot complete the required medical information on your behalf or submit the form. Additionally, we can follow up with the plan on the status of your submission and communicate next steps. See Step 3 for our Prior Authorization and Appeals Guide.
Product acquisition information and resources
LEQVIO® can be ordered through our authorized distributors. The Service Center can provide you with a complete list of authorized distributors and can connect you with a Field Reimbursement Manager in your area to assist with this process. See Step 3 below for our Distribution Flashcard.
Eligible, commercially insured patients may pay as little as $0 for each LEQVIO treatment. Limitations apply. Subject to terms and conditions.† If a patient meets the eligibility criteria, the Service Center will provide you and the patient with the co-pay card information as well as instructions on how to submit for reimbursement. We've included our Co-pay Flashcard in Step 3.
Billing and coding support
The Service Center has educational resources and information about the proper coding for reimbursement, specific guidance around HCPCS codes, CPT codes, NDC codes, ICD-10 codes, sample claim forms, and a claim filing checklist. Find our Billing and Coding Guide below in Step 3.
The Service Center Portal
A secure and easy way to electronically enroll and manage all of your patients receiving LEQVIO in one place. Practice registration is required. Visit ServiceCenterPortal.com to get started.
1-page Paper Start Form
Download and complete a paper Start Form, then fax to 877-537-8468 (877-LEQVIO8).
The LEQVIO Co-Pay Portal
Designed to help you enroll your patients in co-pay savings, submit co-pay claims for reimbursement on behalf of your patients, and track payment status.
Visit LEQVIO-CopayPortal.com to get started.
Your patients can also enroll themselves—simply direct them to LEQVIO.com to learn more.
You selected buy-and-bill
Buy-and-bill is a method for acquiring specialty drugs covered under the Medical Benefit. Your office purchases LEQVIO from an authorized distributor, receives and administers the product, then submits for reimbursement for the cost of the product and the administration fee.
You selected specialty pharmacy
Your office orders from a specialty pharmacy and administers the product, then submits a claim for the cost of administration. The specialty pharmacy works with the patient on their out-of-pocket responsibility for the product.
Product ordered through specialty pharmacy must be given to the specific patient for whom it was ordered (unlike with buy-and-bill, in which the product can be given to any patient for whom it's prescribed).
Did you know? If your patient is covered under Medicare Part B for their LEQVIO treatment, you must acquire their medicine via buy-and-bill. To learn more, visit SpecialtyDrugResource.com.
Billing & Coding Guide
A resource for HCPs and office staff that includes the relevant codes that are needed in order to complete claim forms to receive reimbursement for products and services. It will also contain distribution information, key checklists and sample letters for claims, appeals, and buy-and-bill readiness.
Prior Authorization & Appeals Guide
Have additional questions or need more support?
Our specialists are available to help. Please call us at 833-LEQVIO2 (1-833-537-8462) or use our click-to-chat option at LEQVIO-access.com to connect with one of our specialists.
*Bridge to Commercial Program Terms & Conditions: Eligible patients must have commercial insurance, a valid prescription for LEQVIO, and a prior authorization that has been denied or pending for greater than 3 calendar days. Program provides up to two (2) doses of free medication. Program is not available to patients who are uninsured or whose medications are reimbursed in whole or in part by Medicare, Medicaid, TRICARE, or any other federal or state program, or where prohibited by law. No purchase necessary. Program is not health insurance, nor is participation a guarantee of insurance coverage. Other limitations may apply. Novartis reserves the right to rescind, revoke, or amend the Program and discontinue support at any time without notice.
†Limitations apply. Valid only for those with commercial insurance. The Program may include the Co-pay Card, Payment Card (if applicable), and Rebate. Per treatment maximums and an annual benefit cap apply. For patients covered under the medical benefit, rebate for out-of-pocket costs will be assigned directly to provider, unless patient requests direct reimbursement. Patient is responsible for any costs once limit is reached in a calendar year. Program not valid (i) under Medicare, Medicaid, TRICARE, VA, DoD, or any other federal or state health care program, (ii) where patient is not using insurance coverage at all, (iii) where the patient's insurance plan reimburses for the entire cost of the drug, or (iv) where product is not covered by patient's insurance. The value of this program is exclusively for the benefit of patients and is intended to be credited towards patient out-of-pocket obligations and maximums, including applicable co-payments, coinsurance, and deductibles. Program is not valid where prohibited by law. Patient may not seek reimbursement for the value received from this program from other parties, including any health insurance program or plan, flexible spending account, or health care savings account. Patient is responsible for complying with any applicable limitations and requirements of their health plan related to the use of the Program. Valid only in the United States and Puerto Rico. This Program is not health insurance. Program may not be combined with any third-party rebate, coupon, or offer. Proof of purchase may be required. Novartis reserves the right to rescind, revoke, or amend the Program and discontinue support at any time without notice.
Novartis Pharmaceuticals Corporation
East Hanover, New Jersey 07936-1080
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