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ABOUT INSUPPORT

By enrolling in INSUPPORT, you can receive the following:

  • A benefit investigation of insurance coverage for SUBLOCADE® (buprenorphine extended-release) injection, for subcutaneous use (CIII) based on your current treatment provider, or based on a new site of care if you are transitioning to a new healthcare setting
  • Information on the prior authorization (PA) and/or appeals process for SUBLOCADE from your insurance provider, where applicable
  • Enrollment in the Copay Assistance Program, if determined eligible*
  • A written benefit summary with detailed coverage information for SUBLOCADE as reported by your insurance provider, if requested on the Patient Authorization
  • A benefit summary call from your INSUPPORT case manager to review benefits and address coverage or copay questions, if requested on the Patient Authorization
  • Text notifications related to your enrollment, if applicable and requested on the Patient Authorization
  • Information on potential alternative funding sources, if applicable

Copay Assistance

Learn how INSUPPORT may be able to help with the out-of-pocket cost of SUBLOCADE® (buprenorphine extended-release) injection for subcutaneous use (CIII).

INSUPPORT COPAY ASSISTANCE PROGRAM

*The INSUPPORT Copay Assistance Program is valid ONLY for individuals with private insurance who are prescribed SUBLOCADE for on-label use. Individuals with government insurance are not eligible for the Copay Assistance Program, including, but not limited to, Medicare, Medicaid, Medigap, VA, DoD, TRICARE, CHAMPVA, or any other federally or state-funded government-assisted program. Other restrictions apply.

INSUPPORT is here to help you

What is a Benefit Summary?

When you enroll in Benefit Coverage Information, INSUPPORT will conduct a benefit investigation of your health insurance coverage for SUBLOCADE. You will receive the information obtained by INSUPPORT from your insurance provider in a summary letter. If you requested enrollment in the Copay Assistance Program for SUBLOCADE and you are eligible, INSUPPORT will enroll you in the program and provide the copay member information to you in a separate communication. You may call INSUPPORT to change your communication preferences at any time.

How can an INSUPPORT Case Manager assist me?

An INSUPPORT case manager is available when you enroll in INSUPPORT. Your INSUPPORT case manager will call you to walk you through your benefit coverage for SUBLOCADE as reported by your insurance provider, explain the next steps in the process to receiving your prescription, and answer any questions you may have. You may contact your case manager at any point for additional information.

What you may need to enroll in INSUPPORT:

Patient Enrollment Form

To enroll in INSUPPORT, you and your healthcare provider must complete the required sections of the Patient Enrollment Form. This form may be completed and submitted to INSUPPORT in two ways: online or via fax.

Your healthcare provider may enroll you in INSUPPORT online using the INSUPPORT Portal. If you are enrolled online, you may receive an email request from your healthcare provider to complete your Patient Authorization electronically via electronic signature. INSUPPORT will begin to process the enrollment request only after your completed form(s) have been received.

You may also work with your healthcare provider to enroll in the INSUPPORT Program using the paper Patient Enrollment Form. Once all required sections are completed, your healthcare provider must fax all pages of the completed form to INSUPPORT.

If you choose not to enroll in INSUPPORT, you can still be treated with SUBLOCADE (buprenorphine extended-release) injection, for subcutaneous use (CIII).

Patient Authorization Form

This form is included as a part of the Patient Enrollment Form and exists as a stand-alone form, if needed. Your completed Patient Authorization Form allows your healthcare provider to share your personal health information with INSUPPORT and other listed entities that will assist in completing your request. In the event your Patient Authorization Form was not completed in your healthcare provider's office, you may submit the form in INSUPPORT in two ways: online or via fax. You may choose to enroll or discontinue use of INSUPPORT at any time.

IMPORTANT TO REMEMBER:

You must complete all required sections, sign and date the form, and return all pages to INSUPPORT in order to enroll in the Program. You may also cancel your enrollment by contacting INSUPPORT at any time.

SUBMIT AUTHORIZATION ONLINE

INSUPPORT Portal

FAX AUTHORIZATION FORM

DOWNLOAD authorization FORM

If you require assistance in other languages, then please call INSUPPORT at 1-844-INSPPRT (1-844-467-7778)

Copay Assistance

Learn how INSUPPORT may be able to help with the out-of-pocket cost of SUBLOCADE® (buprenorphine extended-release) injection for subcutaneous use (CIII).

INSUPPORT COPAY ASSISTANCE PROGRAM