1 Astellas Pharma US, Inc. XTANDI Access Services SM 2015 NCCN Virtual Reimbursement Resource Room Guide The oncology reimbursement landscape continues to present ever-evolving challenges for clinicians and others who work with patients with cancer. As a response to these ongoing challenges, help is available at the NCCN Virtual Reimbursement Resource Room at. Users can search by cancer type or supportive care indication, drug name, or by reimbursement or assistance program to learn about available reimbursement help and services to help mitigate reimbursement challenges. Visit the NCCN Virtual Reimbursement Resource Room today and learn about available reimbursement help and services at: FREE App available on Google Play or Apple Store
2 NCCN Virtual Reimbursement Resource Room Astellas Pharma US, Inc. XTANDI Support Solutions SM Guide Astellas Pharma US, Inc. XTANDI Support Solutions SM 3 Biodesix 5 Boehringer Ingelheim Solutions Plus 5 Bristol-Myers Squibb Access Support 6 BTG International Inc. 6 Celgene Patient Support 7 Eisai Assistance Program (EAP) 7 Genentech Access Solutions 8 IncyteCARES (Incyte Corporation) 8 Lilly PatientOne: Reimbursement & Patient Assistance Program 9 Medivation, Inc. 10 Onyx Pharmaceuticals 10 Patient Access Network (PAN) Foundation 10 Patient Assistance NOW Oncology (PANO) (Novartis Oncology) 11 REACH (Resource for Expert Assistance and Care Helpline) (Bayer HealthCare Pharmaceuticals) 12 Seattle Genetics SeaGen Secure 13 Teva Oncology: CORE (Comprehensive Oncology Reimbursement Expertise) 13 Xofigo Access Services (XAS) Program 14 ZytigaOne TM Support 15
3 3 Astellas Pharma US, Inc. XTANDI Support Solutions SM Your Patients Your Practice Your Choice XTANDI Support Solutions SM is designed as a single point of contact to help patients and their loved ones understand their coverage and reimbursement options for XTANDI (enzalutamide) capsules. Astellas is firmly committed to ensuring our patients have access to XTANDI, regardless of their financial status. We are here to answer questions about your insurance coverage and options for filling your prescription in order to get you started on therapy as quickly as possible. Flexible and integrated resources for patient access and support: Covers the needs of patients with private insurance and Medicare, as well as uninsured patients Physicians can send a prescription directly to a Specialty Pharmacy Provider in the network, HUB call center, or self-dispense out of an office based pharmacy Provides patient benefit verification and support with prior authorization and appeals assistance XTANDI Patient Savings Program SM Co-pay assistance for privately insured patients One time enrollment per year or 12 monthly refills Patients pay no more than $20.00/month with an annual maximum benefit of up to $12,000/year Quick Start+ for XTANDI To enable rapid initiation of treatment, the Quick Start+ program for XTANDI provides a one-time, 14-day gratis fill supply of XTANDI that requires a physician prescription. Quick Start+ is intended for new patients who have not received a coverage decision from their payer (for example, a benefit verification or prior authorization is pending) in time to start therapy in 10 business days. Quick Start+ offers several benefits: Allow patients to start treatment with XTANDI while XTANDI Support Solutions SM troubleshoots issues Provides quick delivery time so patients can start therapy as soon as possible Offers direct-to-patient shipping Continued on next page
4 4 Astellas Pharma US, Inc. XTANDI Support Solutions SM Continued from previous page Astellas Access Program SM Astellas is committed to supporting and maintaining access to medications for patients who are treated with an Astellas product. The Astellas Access Program SM for XTANDI is designed for patients who have no health insurance. This program provides free XTANDI to patients who qualify for enrollment based on insurance and household income status. Eligibility is determined on a patient-specific basis. XTANDI Support Solutions SM can quickly determine whether a patient is eligible for enrollment. If you need assistance with the Astellas eservice site, XTANDI Support Solutions SM or have any questions on coding, coverage, and reimbursement for Astellas products, please contact us between the hours of 9:00 am and 8:00 pm ET Monday through Friday. Contact Us XTANDI Support Solutions SM Monday Friday, 9:00 am 8:00 pm ET Phone: XTANDI ( ) Fax: Mailing Address: Astellas Access Services SM P. O. Box La Jolla, CA For Full Prescribing Information please see or contact Astellas Medical Communication at XTANDI and Astellas are trademarks of Astellas Pharma Inc. XTANDI Support Solutions SM is a component of Astellas Access Services SM.
5 5 Biodesix VeriStrat is a serum protein test that is predictive of significant differential overall survival treatment benefit between erlotinib and single-agent chemotherapy for patients with advanced NSCLC who are EGFR wild-type or whose EGFR mutation status is unknown. The test is used in patients who have progressed after or are ineligible for platinum-based doublet chemotherapy. For Patients with Medicare: VeriStrat is covered by Medicare for patients with non-small cell lung cancer who are EGFR wild-type or whose mutation status is unknown. For Patients with Private Insurance: Biodesix will file the claim and any necessary appeal with the patient s insurance company. The amount the patient is required to pay for VeriStrat testing depends on their insurance plan. The patient may be responsible for a co-payment, co-insurance, or a deductible. Biodesix Assist Financial Support Program: If the patient has a financial responsibility, the patient s insurance does not cover VeriStrat, or the patient does not have insurance, they may be eligible for the Biodesix Assist Financial Support Program, which may help to reduce or eliminate the cost of the test. If you have any questions at all regarding coverage and payment, please contact the VeriStrat Support Hotline at Boehringer Ingelheim Solutions Plus Making patient support our priority by providing a broad range of access, reimbursement and clinical support solutions for patients who are prescribed GILOTRIF (afatinib) tablets. Our goal is to help patients quickly and affordably access GILOTRIF Additionally, we provide patient education, adverse event and dose management support to complement care Improving the overall patient support experience Single, dedicated specialty pharmacy, Accredo Single point of contact Efficient, reliable service Consistent patient support Innovative programs to support treatment Call Solutions Plus at from 8 am to 8 pm EST or online at
6 6 Bristol-Myers Squibb Access Support Bristol-Myers Squibb Oncology is committed to helping appropriate patients get access to our medications by providing reimbursement support services for healthcare professionals. Bristol-Myers Squibb Oncology: Access Support is a comprehensive resource for Reimbursement Support Services and Patient Assistance that offers access services for patients including: Benefit Investigation Appeals Assistance Alternative coverage search Prior Authorization Assistance Patient Assistance To learn more about BMS Access Support, please visit our web site or call the toll-free number to speak with a reimbursement counselor. Phone: Monday Friday, 8:00 am to 8:00 pm ET BTG International Inc. BTG is a specialist healthcare company focused on three business areas: Interventional Medicine, Specialty Pharmaceuticals and Licensing. BTG s Interventional Medicines include Interventional Oncology products used to treat patients with liver tumors and Interventional Vascular products used to treat patients with severe blood clots and patients with varicose veins in the great saphenous vein system of the leg. BTG s Specialty Pharmaceutical products include antidotes to treat snake envenomation and toxicity associated with medicines used for heart conditions and cancer. Company and product website addresses:
7 7 Celgene Patient Support Celgene Patient Support provides a dedicated, central point of contact for patients and healthcare professionals who use Celgene products. Celgene Patient Support is a free service that helps patients and healthcare professionals navigate the challenges of reimbursement, providing information about co-pay assistance, and answering questions about obtaining Celgene products. Facilitate prior authorization Assist with appeal support after insurance denials Navigate your Medicare coverage Assess co-pay options Follow up on your prescription status Help you apply for the Celgene free medication program Guide you through Celgene products and restricted distribution programs or Eisai Assistance Program (EAP) Eisai s commitment to innovative solutions in disease prevention, treatment and care for the health and well-being of people worldwide is embodied in our human health care (hhc) mission: we give first thoughts to patients and their families by helping to ensure access to necessary medicines. With this in mind, the Eisai Assistance Program (EAP) provides dedicated reimbursement and access support for patients and healthcare professionals to reduce barriers to patient access to medicines. Specifically, EAP offers the following services: insurance verification prior authorization information appeal information alternate coverage/funding information Patient Assistance Program (PAP) enrollment expediting product access and minimizing barriers to access To learn more about the Eisai Assistance Program, please visit our website or call our toll-free number EISAI.4.U ( ) or
8 8 Genentech Access Solutions We Focus on Access So You Can Focus on Health If you are concerned about paying for your Genentech medicine, we are here to help. Whether you have health care coverage or not, we can help you by: Finding out if your health care plan pays for your medicine Guiding you through the process of getting your medicine Connecting you with our patient assistance programs Visit to learn more about these programs and how to get started. To speak live with one of our Specialists, call (866) 4ACCESS/(866) IncyteCARES (Incyte Corporation) IncyteCARES (Connecting to Access, Reimbursement, Education and Support) was established by Incyte to assist providers, patients, and caregivers through a single point of contact with reimbursement assistance, patient access, and distribution coordination for Jakafi (ruxolitinib). IncyteCARES assists healthcare professionals and eligible patients with product access through a suite of services, including: Benefit verification, prior authorization and appeals assistance, and Jakafi delivery coordination Co-pay assistance for privately insured patients who meet the program s eligibility requirements Access to Jakafi free of charge for patients who do not have insurance and meet the program s eligibility requirements Referral to independent and nonprofit organizations that may be able to provide financial assistance Patient education and support You can contact IncyteCARES, between 8:00 am 8:00 pm, by calling: JAKAFI ( ) or visit for more information.
9 9 Lilly PatientOne: Reimbursement & Patient Assistance Programs The Lilly PatientOne program is committed to helping eligible patients access support programs for Lilly Oncology products they are prescribed. It aims to address both financial and coverage issues for qualified uninsured, underinsured, and insured patients who are prescribed a Lilly Oncology product. PatientOne strives to offer resources, ranging from benefits investigations to financial assistance and appeals information, that provide reliable and individualized treatment support for eligible patients. Services offered by this program include: Insurance Expertise Coding and billing information Payment methodologies and allowables Payer policy information Patient Assistance Program Drug replacement for eligible patients Financial Assistance Information about co-pay assistance foundations Co-pay program to assist eligible patients with out-of-pocket costs for specific Lilly Oncology products where available Reimbursement Assistance for Eligible Lilly Oncology Products for an Approved Diagnosis Eligibility determination Benefits investigation Prior authorization Evaluation of other fund options Denied Claim Appeals Appeals status if requested Denied claims appeals templates, forms, and checklists For more information call 866.4PatOne ( ) Monday Friday, 9:00 am 7:00 pm EST or visit
10 10 Medivation, Astellas Pharma Inc. US, Inc. XTANDI Support Solutions SM To learn about this program, visit Text Onyx Pharmaceuticals Onyx 360 sets a new standard of personalized treatment support for patients, caregivers, and practices. You and your patients will have access to a dedicated Oncology Nurse Advocate and a wide range of services and support, including: Reimbursement Assistance Co-pay/Co-insurance assistance Free product assistance for eligible patients Clinical Support Information about the disease Side effect management Referrals to Third-party Organizations for Day-to-Day and Emotional Support Assistance with transportation to scheduled appointments Patient and caregiver counseling services Support group information Talk to Your Patients About Onyx 360 Today. To learn more about these services, please call ONYX.360 ( ). Patient Access Network (PAN) Foundation ( ) The Patient Access Network (PAN) Foundation provides help and hope to underinsured patients with chronic or life-threatening illnesses to more than 50 disease-specific co-payment assistance programs. Since 2004, PAN has provided over $700 million in financial assistance to more than 300,000 patients who would otherwise be unable to afford their mediations. PAN makes it simple for patients and providers to obtain the financial assistance they need quickly through a streamlined application process and online portals.
11 11 Patient Assistance NOW Oncology (PANO) (Novartis Oncology) Helping to make access to the therapies you need easier Novartis Oncology is committed to helping patients living with cancer receive the medicines they need. Patient Assistance NOW Oncology offers quick and easy access to information about the broad array of support and reimbursement programs available. You can get information about our Patient Assistance NOW Oncology support programs in 2 ways: Call to speak with a member of our knowledgeable staff dedicated to making access to our programs as simple and convenient as possible; or Visit our website at: Support for patients includes: Insurance verification Coding/billing questions Medicare education Therapy-specific support programs for out-of-pocket costs Alternative assistance searches and referrals to federal or state assistance programs Referrals to independent charitable foundations for assistance with co-pay costs Assistance with denials/appeals Patient assistance for low-income and uninsured patients Patients prequalifed via phone screening for the Patient Assistance Program (PAP) will be sent a 30-day supply of their needed medication while completing the application Convenient provider portal to access program services or check the status of patients enrolled
12 12 REACH (Resource for Expert Assistance and Care Helpline) (Bayer HealthCare Pharmaceuticals) The REACH program assists patients with their coverage options for Nexavar (sorafenib) tablets and Stivarga (regorafenib) tablets. Nexavar and Stivarga are distributed through designated specialty pharmacy providers (SPPs); it is not available through retail pharmacies. A REACH program counselor will work with Payers and patients to identify an SPP that will fill the Nexavar or Stivarga prescription and send it directly to the patient s home. A REACH program counselor will also call patients to provide help in understanding insurance coverage and the Medicare Part D drug benefit and aid in finding other sources of payment for Nexavar or Stivarga. Enrollment forms are available via REACH at ( ), Monday through Friday from 9:00 am to 8:00 pm EST, or at or The Reimbursement Support Line team has experience with all payer types, including Medicare. Questions answered by the team typically can be classified into one of the following groups: Benefit verification Coding information and billing instruction Claims review Claims-appeal assistance Prior-authorization assistance Patient assistance The On-call Team closely monitors the reimbursement environment for latest changes in Medicare, Medicaid, and private payer reimbursement and coverage polices. In addition, Bayer HealthCare Pharmaceuticals offers a patient assistance program that provides assistance to uninsured patients who meet the program requirements.
13 13 Seattle Genetics SeaGen Secure SeaGen Secure TM is a comprehensive assistance program for patients who have been prescribed ADCETRIS TM (brentuximab vedotin) and for the healthcare providers caring for them. Services offered by the program include: Patient Assistance and Reimbursement Support Benefits Verification Prior Authorization Assistance Co-insurance Assistance Claims Tracking Appeal Assistance and Tracking Billing and Coding Support General Payer and Policy Research Teva Oncology: CORE (Comprehensive Oncology Reimbursement Expertise) Teva Oncology: CORE (Comprehensive Oncology Reimbursement Expertise) offers reimbursement support for branded Teva Oncology products. Some of the options include benefit verification, prior authorization support and customer service through the claims and appeals process. CORE also provides referrals to the Teva Cares patient assistance program. For more information or an introductory consult please call or visit
14 14 Xofigo Access Services (XAS) Program Xofigo Access Services (XAS) Program is a single point of contact to process all Xofigo (radium Ra 223 dichloride injection) orders distributed through a single designated Specialty Pharmacy Provider. XAS is a platform to provide all market access support (e.g. PAP, copay assistance, BV) for referring and treating providers, an integrated solution for order management with Cardinal Health, and data collection point to track and maintain information collected from performed provider services. A Xofigo Access Services counselor will work with the provider to help patients in understanding their individual insurance coverage and aid in finding the best support options for Xofigo. Xofigo Access Services Intake forms, Patient Assistance forms, & Benefit Verification request forms are available at or via phone ( Xofigo) ( ) Monday through Friday 9:00 am 8:00 pm EST. The Xofigo Access Services Support includes: Product Order and Patient Scheduling Confirmation Product Order request processing Appointment and treatment schedule confirmation Seamless transfer for administrating provider to Cardinal Health Questions regarding returns, damaged product, patient cancellations, or rescheduling Reimbursement Support Insurance benefit verifications Prior authorization support Claims appeal research and information Claims tracking Billing and coding information Payer policy information Patient Assistance Program Assistance for qualified uninsured and underinsured patients who meet specific criteria Copay Assistance Program Copay assistance for qualified commercially insured patients Copay assistance triage to foundations for other insured patients
15 15 ZytigaOne Support Janssen Biotech, Inc., the manufacturer of ZYTIGA (abiraterone acetate), has developed ZytigaOne Support to help make access to ZYTIGA simple, convenient, and easy. ZytigaOne Support provides focused attention and personalized support to help you and your patients with access to ZYTIGA. Support For You Rapid investigation and assessment of patient eligibility and coverage Assistance with the prior authorization and appeal process, plus concise benefit summary to physicians and staff Information on cost support options, including updates on independent foundation funding status Electronic enrollment through an online portal Identification of a Specialty Pharmacy Provider (SPP) Access to medication order information A personally-assigned Site Coordinator Support For Your Patients Explanation of benefits from a personally-assigned Care Coordinator Referral to cost support options, including the ZytigaOne Instant Savings Program for eligible patients Upon request, follow-up status calls to those referred for cost support Coordination with SPP for processing and delivery of medication Educational materials and personalized prescription reminders, if requested Visit for more information about how to enroll patients in ZytigaOne Support or call your personally assigned ZytigaOne Support Site Coordinator today. Contact ZytigaOne Support ZYTIGA-1 ( ) Monday Friday, 8:00 am 8:00 pm ET Before prescribing ZYTIGA (abiraterone acetate), please see full Prescribing Information including Dosage and Administration, Warnings and Precautions available at
16 16 NCCN Reimbursement Resource App The cost of cancer care continues to rise and patients with cancer and their caregivers often struggle to pay for therapy. As a response to these ongoing challenges, help is available through the NCCN Reimbursement Resource App; users are able to search for available resources and payment assistance programs. Search by: Cancer Type or Supportive Care Indication Drug Name Reimbursement or Assistance Program Download for Free! The NCCN Reimbursement Resource App for Patients, Caregivers, and Health Care Professionals Now available for Apple and Android smartphones and tablets! Visit the App Store SM Search NCCN Apple is a trademark of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Google Play is a trademark of Google Inc. Android is a registered trademark of Google. Visit the Google Play Store Search NCCN Technical development supported by ARIAD Pharmaceuticals, Inc.; Genentech, a Member of the Roche Group; and Teva Oncology. Now available for smartphones and tablets! 275 Commerce Drive Suite 300 Fort Washington, PA NCCN.org For Physicians NCCN.org/patients For Patients NCCN.org-N