Q. What is this service and how does it work?

A. Astellas Reimbursement Services^SM (ARS) has reimbursement specialists experienced in verifying insurance coverage requirements for Mycamine. Healthcare providers complete a Benefit Verification Request Form and fax it to ARS with the patient’s signed authorization and a photocopy of the front and back of the patient’s insurance card(s). An ARS reimbursement specialist will contact the patient’s insurance company within one business day to research their coverage for Mycamine, including the process for prior authorization if needed, patient cost share, and other coverage and access details. Then, ARS will fax the healthcare provider a Summary of Benefits detailing all of the coverage information obtained from the patient’s insurance company.

Q. I have a patient with Medicare. How do I find out whether Mycamine is covered under Part B or Part D for my patient?

A. ARS is experienced in understanding Medicare coverage guidelines for Mycamine. Our reimbursement specialists can assist you in determining where the coverage may lie through patient-specific benefit verifications. For more information on Mycamine coverage under Part B and Part D, please review the Medicare payer overview.

Q. Do I have to fill out a Benefit Verification Request Form for each of my patients who require Mycamine?

A. No, but the benefit of doing that is that each patient is likely to have differences in their coverage (even patients with the same plan or employer can have different coverage). Researching coverage, coding, and reimbursement information on a patient-specific basis will give you the most comprehensive information so your patients will have access to the medication that has been prescribed.

Q. What is the value of asking ARS to do a benefit investigation prior to providing treatment with an anti-infective?

A. By asking ARS to conduct a benefit investigation, the patient and provider may:

• Receive verification that the patient has coverage for Mycamine
• Identify if there are any utilization restrictions such as prior authorization that, if not addressed proactively, could impede patient access to the medication
• Understand the patient’s cost share obligations so that any access issues are identified

Q. Can ARS secure prior authorization on the patient's behalf?

A. ARS cannot submit the prior authorization request on behalf of a healthcare provider. ARS can:

• Support your practice or facility through every step of the prior authorization process
• Provide contact information for submission of the prior authorization request (phone, fax, or mailing address)
• Determine what information is needed to support medical necessity, report payer’s decision turnaround time, and confirm how the site will be notified of the outcome by the payer
• Provide any payer-specific Prior Authorization forms and a template letter of medical necessity for customization by the healthcare provider
• Call the payer to check on the status of the prior authorization and follow up with the practice or facility to communicate the status

Q. How does ARS handle sensitive patient information?

A. ARS only obtains patient information for the purpose of verifying coverage for Mycamine and to help patients access therapy. ARS may use patient information to evaluate eligibility for the Astellas Access Program^SM (AAP), which provides no-cost stock replacement of injectable medications that have been administered to qualifying uninsured patients. ARS will never use patient information for any other purpose.

ARS requires providers to fax a Patient Authorization to Disclose Health Information Form (also known as a HIPAA form) signed by the patient. Healthcare providers can fax a current HIPAA form already on file at the practice or facility, or can obtain a new form by:

• Downloading a copy from the Forms and Documents section
• Calling ARS at 1-800-477-6472 to request a form

Privacy laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) require that a patient’s written authorization be obtained before identifiable health information may be disclosed to or received by ARS.

Patient’s personally identifiable information (PII) or protected health information (PHI) is handled and collected in strict accordance with all applicable laws.