Enrollment and Authorization Forms
This form is used to enroll a patient in INSUPPORT™ services. Start by selecting the service(s) requested by the patient and complete the required steps outlined on the Form. Please ensure that the patient reads, understands, signs, and dates the Patient Authorization and Consent page of the Patient Enrollment Form, if required. This form is also available in Spanish.
If this form is not signed and dated by the patient while in the office as part of the Patient Enrollment Form and signature is required to initiate the requested service, the patient may review, sign and date this form, and return it to INSUPPORT™. This form can also be completed and provided to INSUPPORT™ at the time of copay re-enrollment, if applicable, when there has been no change in insurance information or treatment provider from the previous enrollment.
INSUPPORT™ cannot provide reimbursement for medical copay claims unless an Enrollment Form or a Certification Form is on file for any patient. If you have not enrolled a patient in the INSUPPORT™ Copay Assistance Program for PERSERIS, you must complete this form and submit to INSUPPORT™ in order to receive reimbursement for copay claims.
This form will provide additional information on completing an INSUPPORT™ Patient Enrollment Form for PERSERIS.
INSUPPORT™ can research the patient's insurance benefits for PERSERIS for patients enrolled in Full Hub Services or the Insurance Verification Only Service. This resource provides detailed information about the Benefit Summary from INSUPPORT™.
This sample letter offers examples of full additional information that may be helpful when requesting a reevaluation of a patient's denial for PERSERIS coverage by the insurance provider.
This sample letter offers examples of additional information that may be required by an insurance provider to demonstrate that treatment with PERSERIS is warranted, appropriate, and medically necessary.
Neither INSUPPORT™, nor Indivior Inc., makes any warranties, expressed or implied, about the accuracy of the insurance coverage information, nor is this a guarantee of current or future coverage and/or reimbursement for any Indivior product. Patients and healthcare professionals should always verify actual coverage, coding, patient out-of-pocket costs, and reimbursement guidelines with an insurance provider on a patient-specific basis.
Find an Injection Location
Search the PERSERIS Patient Injection Network (PIN) to find an injection location near your patient that can administer PERSERIS for you.
WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA‑RELATED PSYCHOSIS
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. PERSERIS is not approved for the treatment of patients with dementia-related psychosis and has not been studied in this population.
Please see the full Prescribing Information including BOXED WARNING and Highlighted Safety Information for PERSERIS™ (risperidone) for extended-release injectable suspension.
This form may be used by a healthcare provider to refer a patient directly to a PIN location if not using INSUPPORT's Full Hub Services.
Find a Field Reimbursement Specialist (FRS)
This brochure provides an overview of the INSUPPORT™ services.
This brochure offers detailed information about getting started with the INSUPPORT™ Provider Portal to electronically manage patient cases for those enrolled in INSUPPORT™.
This guide provides information on PERSERIS billing and coding for claims submissions to the patient's insurance provider.
This document provides details about patient eligibility and enrollment requirements as well as the benefits and conditions for the INSUPPORT™ Copay Assistance Program for PERSERIS.
INSUPPORT™ offers a list of specialty distributors that distribute PERSERIS.
This short video provides an overview of INSUPPORT™ and the services it provides.
For the Patient
INSUPPORT™ was designed to help facilitate patient access to PERSERIS.
This brochure provides patients with detailed information about the INSUPPORT™ Copay Assistance Program for PERSERIS.
This brochure provides patients and caregivers with detailed information about INSUPPORT™.
This brochure offers the patient information about getting started in the INSUPPORT™ Patient Portal, where they can monitor case or copay information with INSUPPORT™.
This is a glossary to help patients understand common insurance terms.