Understanding your patient’s coverage
After enrollment, a Nurse Navigator will work to determine your patient’s coverage options
Models are used for illustrative purposes only.
Benefits verification*
Your patient’s Nurse Navigator will conduct a benefits investigation within 1 business day of enrollment to determine if their insurance plan covers their medication. They will provide a summary of coverage options, including information on:
- Out-of-pocket costs
- Exclusions
- Prior authorization and appeals processes
- Specialty pharmacies within your patient’s network
Prior authorizations†
Your patient’s Nurse Navigators will provide information on the payer prior authorization process and submission requirements for their insurance plan. We’ll keep you and the specialty pharmacy updated on the status and expirations of your patient’s prior authorization.
Medical necessity
For patients who may need immediate attention. Nurse Navigators can provide information on financial assistance programs that may be available to your patient and help address hurdles that could delay starting their Takeda Oncology medication. For patients who may need immediate attention, expedited requests to their insurance provider stating their medical necessity may be needed. A downloadable Sample Letter of Medical Necessity is available here.
Payer denials†
If a denial of payment occurs, we can help explain the reasons for denial and provide information on the appeal process. Get started with the Sample Letter of Appeal template available here.
Bridge Program
For patients with a temporary gap in commercial coverage or authorization (job loss, insurance, transition):
Bridge Program offers MIMRYLO at no cost for up to 2 months.
Eligibility‡:
Patient must have been on MIMRYLO prior to coverage loss
MIMRYLO coverage was from a commercial health plan
Terms and Conditions apply.
‡Additional eligibility requirements apply.
*Verification of benefits is not a guarantee of payment and does not take the place of written policy information. Healthcare providers should carry out their own benefits investigation, as necessary.
†Takeda Oncology Here2Assist does not complete forms, file claims, submit prior authorizations or appeal claims on behalf of the physician or caller. Takeda Oncology Here2Assist cannot assist with or guarantee success in obtaining payer approval.