![]() In some denial cases, a plan may require a peer-to-peer review with a medical reviewer at the health plan. You can refer to for the appeals kit, which will provide information about the process of appealing a denial, and reference sample letters provided by DUPIXENT MyWay. In the case of a denial, you may consider writing an appeal, if appropriate, making sure to address the plan’s specific concerns. Appealing the health plan’s denial does not always result in approval of DUPIXENT. There are several reasons for this, including incomplete documentation, administrative errors, clinical reasons or a no-coverage determination, or a plan exclusion.Īpproval is not guaranteed. ![]() It is important to note that a plan may deny prior authorization. The prior authorization information required by the patient’s insurance to approve coverage for DUPIXENT may include the patient’s history, medication, and clinical information. DUPIXENT MyWay will not conduct the benefits investigation, nor send a Summary of Benefits Form, for providers who have checked the specialty pharmacy box on the Enrollment Form, as this indicates that they wish the specialty pharmacy to conduct the benefits investigation.ĭUPIXENT MyWay can provide certain limited support Some plans, including commercial and Medicare, may even have a separate pharmacy benefit card.Ī Summary of Benefits Form will be faxed to your office within a few days, detailing the patient’s coverage-including prior authorization requirements and out-of-pocket costs. Key points of contact for coverage are located on the card itself. It’s important to understand how to identify prescription drug coverage. Once enrolled, a benefits investigation to determine coverage begins. It is important that the patient consents to receiving communication from DUPIXENT MyWay and indicates how they would like to be contacted, whether it be via email, phone, or text. When DUPIXENT is prescribed by a healthcare professional, you can work with the patient to complete the Enrollment Form, and then fax the Enrollment Form with all signatures, dates, and ICD-10 codes to DUPIXENT MyWay. Many specialty medications, such as DUPIXENT, have longer turnaround times because of the prior authorization process. It’s important to understand the specialty pharmacy process and its role in obtaining DUPIXENT. Putting the pieces together for acquiring DUPIXENT.ĭUPIXENT is covered under the pharmacy benefit plan, which requires a patient to coordinate delivery with a specialty pharmacy.Īfter a healthcare provider prescribes DUPIXENT, the patient schedules their delivery of DUPIXENT from the specialty pharmacy, pays the copay, coordinates the shipment, and can administer DUPIXENT themselves or receive the injection from a caregiver after appropriate training from their healthcare provider.
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