Based on your selection, we've created this guide to walk you through the LEQVIO process
Acquire through buy-and-bill and administer in your office
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.
Refer to an alternate injection/infusion center or a hospital outpatient department for administration
You will refer your patient to another site to receive LEQVIO, which may include an injection/infusion clinic or center, hospital outpatient department, or another physician's office.
Acquire through specialty pharmacy and administer in your office
Your office orders from a specialty pharmacy, 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).
To learn more, please visit www.SpecialtyDrugResource.com.
The site is a guide for HCPs and offices to better understand specialty drug coverage and acquisition. This includes helpful educational videos on various topics related to product acquisition, buy-and-bill, as well as coding and reimbursement.
Our Field Reimbursement Managers have experience with access, acquisition, and reimbursement. They can provide education and resources to help with each step in the process. The Service Center can connect you with your dedicated Field Reimbursement Manager. You can call us at 833-LEQVIO2 (1-833-537-8462).
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.
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.
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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