Case managers 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.
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Benefits investigation
Your patient’s case manager will conduct a benefits investigation within 2 business days 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 case manager 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.
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.
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RapidStart Program for delays in insurance coverage
The Takeda Oncology RapidStart Program may be able to help your patient by providing their first month of medication at no cost to them if there is a delay in insurance coverage determination of more than 5 business days.
Select a product from the drop-down menu to download the applicable RapidStart request form.
Note that your patient must be enrolled in Takeda Oncology Here2Assist® to be considered for the RapidStart Program. Terms and conditions 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, or appeal denials of coverage on behalf of healthcare providers. It cannot guarantee success in overturning a payer denial.
‡The RapidStart Program provides a 1-month supply of treatment of the prescribed Takeda Oncology medication at no charge for eligible patients new to therapy experiencing a delay in insurance coverage determination of at least 5 business days. There is no purchase obligation by virtue of a patient’s participation in the RapidStart Program. Patients must have an on-label, valid prescription for the Takeda Oncology medication, and a medical necessity for being prescribed the Takeda Oncology medication. Patients must be enrolled in the Takeda Oncology Here2Assist® Program to qualify. Free product for the RapidStart Program will only be available through the RapidStart Program noncommercial specialty pharmacy. The program may not be combined with any other offer and is not available to patients whose insurers have made a final determination to deny the patient coverage for the prescribed Takeda Oncology medication. Takeda reserves the right to change or end the program at any time. Benefits provided under the program are not transferable.