This site is intended for US healthcare providers

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Resources and Tools
INSUPPORT® can inform you about the steps in the patient access process

Forms

INSUPPORT® Patient Enrollment Form

This form is used to enroll a patient in INSUPPORT®. Start by selecting the program option(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 page of the Patient Enrollment Form. This form is also available in Spanish.

Patient Authorization Form

If this form is completed by the patient as part of the Patient Enrollment Form, the patient may review, sign and date this form, and return it to INSUPPORT® in order to initiate enrollment in the Program. 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.

The INSUPPORT® copay assistance portal

Healthcare providers may enroll an eligible patient in the Program during an in-office appointment by going to www.insupportcopay.com.

Patient Access Journey Sheet

Offers a format that HCP offices may use to record important dates, reminders or next steps along a patient’s access journey to SUBLOCADE treatment.

SAMPLE FORMS
Annotated INSUPPORT® Patient Enrollment Form

This form will provide additional information on completing an INSUPPORT® Patient Enrollment Form.

Sample INSUPPORT® Benefit Summary

INSUPPORT® can research the patient's insurance benefits for SUBLOCADE® (buprenorphine extended-release) injection, for subcutaneous use (CIII) for patients enrolled in Benefit Coverage Information with INSUPPORT®. This resource provides detailed information about the Final Benefit Summary from INSUPPORT®.

Sample Letter of Appeal

This sample letter offers examples of additional information that may be helpful when requesting a reevaluation of a patient's denial for SUBLOCADE coverage by the insurance provider.

Sample Letter of Medical Necessity

This sample letter offers examples of additional information that may be required by an insurance provider to demonstrate that treatment with SUBLOCADE is warranted, appropriate, and medically necessary.

Treatment Provider Locator Opt-In Form

Completing this printable electronic form allows waivered treatment providers to list their practice in the Indivior Treatment Provider Locator.

Treatment Provider Locator Change Request / Opt-Out Form

Completing this printable electronic form allows waivered treatment providers to update or remove their practice listing from the Indivior Treatment Provider Locator.

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.

Tools

Find a Field Reimbursement Specialist (FRS)

This resource will aid in finding a local FRS to provide in-person information to the HCP office.

X
John Doe
INSUPPORT® Field Reimbursement Specialist
Phone: 1 (888) 888-8888
Find a Waivered Treatment Provider

INSUPPORT® can assist in locating a waivered treatment provider*. If you are a waivered treatment provider and you would like to be listed in the Indivior Treatment Locator, you can complete the opt-in form. Or you can update or remove your listing by completing the change request/opt-out form.

This free service provides a list of healthcare providers who are waivered per the Drug Addiction Treatment Act of 2000 (DATA 2000) and the Comprehensive Addiction and Recovery Act of 2016 to provide treatment with SUBLOCADE and who have agreed to be in the lndivior Treatment Locator (Locator).

The Substance Abuse and Mental Health Services Agency also provides treatment information at samhsa.gov/treatment/.

INSUPPORT materials

INSUPPORT® OVERVIEW BROCHURE FOR PROVIDERS

This brochure provides an overview of the INSUPPORT® Program.

BILLING AND CODING GUIDE FOR SUBLOCADE

This guide provides information on SUBLOCADE billing and coding for claims submissions to the patient's insurance provider.

Patient Journey Map

This webpage provides HCP offices with information on key steps typical of a patient’s access journey to receiving SUBLOCADE.

BUY AND BILL CHECKLIST

This flashcard provides a checklist of some considerations for healthcare providers (HCPs) who are contemplating the buy and bill pathway for SUBLOCADE.

The Buy-and-Bill Pathway: Step by Step

This flashcard provides a step-by-step guide to the buy-and-bill process, as well as an overview of the information INSUPPORT® can provide to practices in using the buy-and-bill pathway.

The Specialty Pharmacy Pathway: Step by Step

This flashcard provides a step-by-step guide to the specialty pharmacy process, as well as an overview of the information INSUPPORT® can provide to practices in using the specialty pharmacy pathway.

Copay Assistance Program Terms and Conditions

This document provides details about the eligibility requirements for patients to enroll in and receive benefits under the INSUPPORT® Copay Assistance Program. It also outlines the program’s benefits and conditions.

INSUPPORT® COPAY ASSISTANCE BROCHURE FOR PROVIDERS

This brochure provides healthcare providers with detailed information about the INSUPPORT® Copay Assistance Program for SUBLOCADE.

INSUPPORT® PROVIDER PORTAL USER GUIDE

This brochure offers detailed information about getting started with the INSUPPORT® Provider Portal to electronically manage patient cases for those enrolled in INSUPPORT®.

LIST OF SPECIALTY PHARMACIES

INSUPPORT® offers a list of specialty pharmacies that dispense SUBLOCADE.

List of Specialty Distributors

INSUPPORT® offers a list of specialty distributors that distribute SUBLOCADE.

Videos

Introducing INSUPPORT®

This short video provides an overview of the INSUPPORT® Program.

The Prior Authorization (PA) Process: Step by Step

This short video provides an overview of how to address a PA restriction placed on a specialty medication by a health insurance plan.

The Specialty Reimbursement Process: Step by Step

This short video provides an overview of the reimbursement process for a specialty injectable medication.

The Benefit Investigation Process: Step by Step

This short video provides an overview of how to conduct a benefit investigation for a specialty medication and describes how INSUPPORT® can help.

Specialty Distributors

This short video provides an overview of specialty distributors and the process necessary to purchase specialty medications.

For the Patient

INSUPPORT® was created to provide information on the access process on behalf of patients seeking treatment with SUBLOCADE.

INSUPPORT® OVERVIEW BROCHURE FOR PATIENTS

This brochure provides patients with detailed information about INSUPPORT®.

INSUPPORT® COPAY ASSISTANCE BROCHURE FOR PATIENTS

This brochure provides patients with detailed information about the INSUPPORT® Copay Assistance Program for SUBLOCADE.

INSUPPORT® PATIENT PORTAL USER GUIDE

This brochure offers the patient information about getting started in the INSUPPORT® Patient Portal, where they can monitor case or copay information with INSUPPORT®.

Patient Benefit Summary Glossary of Insurance Terms

This is a glossary to help patients understand common insurance terms.

Product Pathways

You can learn more about acquiring SUBLOCADE by choosing one of the two option below.

Buy-and-Bill
Specialty Pharmacy

Are you waivered to provide treatment with SUBLOCADE in an office setting?

Include your information on the list of waivered treatment providers. If you are a waivered treatment provider and you would like to be listed on or removed from the treatment provider locator, you can choose to complete the opt-in form or change request/opt-out form*.

To list your practice, complete the opt-in form.
DOWNLOAD PDF
To update your existing contact information or to remove your listing, complete the change request/opt-out form.
DOWNLOAD PDF

* This free service provides a list of healthcare providers who are waivered per the Drug Addiction Treatment Act of 2000 (DATA 2000) and the Comprehensive Addiction and Recovery Act of 2016 to provide treatment with SUBLOCADE and who have agreed to be in the lndivior Treatment Locator (Locator).

The Substance Abuse and Mental Health Services Agency also provides treatment information at samhsa.gov/treatment/.