LEQVIO Service Center | Your Custom LEQVIO Support Guide

Based on your selection, we've created this guide to explain the alternate injection/infusion center process

Find an alternate injection/infusion center that is convenient for your patient

Our alternate injection/infusion center locator tool can help you find a center for your patient.

This tool allows you to enter the patient's ZIP Code to identify potential sites for referral.

Follow the proper protocols to refer your patient

Contact the alternate injection/infusion center

Once a center has been identified, contact them to confirm they offer LEQVIO. Make sure to ask about their referral process and order form requirements.

Complete the referral steps required by the center

Ensure your patient's information is sent in a format that is compatible with the center's process. This includes the completed order form, along with the patient's medical history as well as chart notes. Documentation supporting the patient's diagnosis and previous treatments that have been tried and failed is also helpful for insurance coverage purposes.

Alternate injection/infusion center completes a benefits investigation and enrolls your patient in relevant LEQVIO services

Once the center receives the information, they will complete a benefits verification. The site can connect directly with the Service Center for additional support like LEQVIO Co-pay Program enrollment.

IMPORTANT REMINDERS:

Always contact the center to ensure they offer LEQVIO before referring your patient. If they don't offer LEQVIO, you may need to identify a different center
The center will be able to utilize our suite of services. Other than sending the completed order form with support documentation to the treating site and informing your patient of this process, no additional action is required on your part. We have included a summary of our support services below for your reference
If at any point in time, you would like to explore other acquisition methods, including buy-and-bill, the Service Center can connect you with a Field Reimbursement Manager in your local area to provide support. You can reach us at 833-LEQVIO2 (1-833-537-8462)

Familiarize yourself with these helpful resources

Alternate Injection/Infusion Center Administration Journey

A detailed overview of the alternate injection/infusion center process can be found here:

Additional information about LEQVIO Service Center Offerings are listed on the next page

Benefits verification

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, the Service Center can confirm the requirements and provide education around the specific plan processes. If a prior authorization is denied, the Service Center can provide education and resources to help support you during the appeal process.

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.

Product acquisition information and resources

LEQVIO® can be ordered through our authorized distributors. The Service Center can provide you with a list of authorized distributors and can connect you with a Field Reimbursement Manager in your area to assist with this process.

Co-pay support

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.

Billing and coding support

The Service Center has educational resources and information about the importance of proper coding for reimbursement, specific guidance around HCPCS codes, CPT codes, NDC codes, ICD-10 codes, sample claim forms, and a claim filing checklist.

*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

5/22

199369

Your Custom LEQVIO® Support Guide

Find an alternate injection/infusion center that is convenient for your patient

Follow the proper protocols to refer your patient

Familiarize yourself with these helpful resources

Your Custom LEQVIO®
Support Guide