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Patient Enrollment

Enroll your patient in INSUPPORT electronically

Healthcare providers (HCPs) may electronically enroll a patient in INSUPPORT by going to www.insupportportal.com.

Enroll your patient in INSUPPORT via fax

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.

Annotated INSUPPORT Patient Enrollment Form*

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

Patient Authorization Form

Patient Authorization is required for INSUPPORT to initiate any enrollment request. If the authorization is not completed as part of the Patient Enrollment Form while the patient is in the office, patients may provide authorization to INSUPPORT electronically via the INSUPPORT Portal.

INSUPPORT PORTAL OVERVIEW

This resource provides an overview of functionality available for healthcare providers (HCPs) and patients who use the INSUPPORT Portal to provide information to INSUPPORT electronically.

Benefit Coverage Information

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

Annotated 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.

*These annotated samples and samples are intended for informational purposes only and not for direct use as a Patient Enrollment Form, Benefit Summary, Letter of Appeal or Letter of Medical Necessity.

Acquisition of SUBLOCADE

Specialty Pharmacy Pathway

LIST OF SPECIALTY PHARMACIES

INSUPPORT offers a list of specialty pharmacies that dispense SUBLOCADE.

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.

Buy and Bill Pathway

List of Specialty Distributors

INSUPPORT offers a list of specialty distributors that distribute 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.

BUY AND BILL CHECKLIST

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

Reimbursement Information

BILLING AND CODING GUIDE FOR SUBLOCADE

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

Copay Assistance

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

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

COPAY CLAIM SUBMISSION INSTRUCTIONS

Learn more about the INSUPPORT Copay Assistance Program claim reimbursement process.

Transition of Care

TRANSITION OF CARE SUPPORT FOR PROVIDERS

This brochure provides an overview of the information and processes associated with Transition of Care Support for enrolled patients.

SAMHSA'S TREATMENT SERVICES LOCATOR

The Substance Abuse and Mental Health Services Administration (SAMHSA) also provides treatment information. Go to https://findtreatment.samhsa.gov to find a facility near your patient that can provide treatment based on patient-specific criteria. Steps for using SAMHSA's Treatment Services Locator.

CONTINUING CARE REMINDER CARD

For patients who are transitioning to a new healthcare setting for the treatment of SUBLOCADE, this card can be given to the patient to provide important information on next steps such as the patient's next injection due date, the new provider's contact information and appointment information, if applicable.

RESIDENTIAL TREATMENT FACILITY INFORMATION

This document provides information about the coverage and payment modalities for SUBLOCADE within residential treatment facilities.

Find a SUBLOCADE Treatment Provider

INSUPPORT can assist patients in locating a DEA-waivered SUBLOCADE treatment provider. If you are a DEA-waivered SUBLOCADE treatment provider and would like to be included in the Indivior Find a SUBLOCADE Treatment Provider Tool or modify your existing listing, visit ListMyPractice.com.

This free tool provides a list of physicians, nurse practitioners, and physician assistants who have the required legal permissions to treat opioid dependence with FDA-approved medications, have prescribed SUBLOCADE at least once in the previous two years, and have agreed to be included in the Indivior Find a SUBLOCADE Treatment Provider Tool.

General Information

Find a Patient Access Specialist (PAS)

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

X
John Doe
INSUPPORT® Patient Access Specialist
Phone: 1 (888) 888-8888

INSUPPORT OVERVIEW BROCHURE FOR PROVIDERS

This brochure provides an overview of the INSUPPORT Program.

This short video provides an overview of the INSUPPORT Program.

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.

Patient Journey Map

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

For the Patient

INSUPPORT COPAY SAVINGS ENROLLMENT

Appropriate eligible patients can enroll online in the INSUPPORT Copay Assistance Program for SUBLOCADE.

INSUPPORT OVERVIEW BROCHURE FOR PATIENTS

This brochure provides patients with detailed information about INSUPPORT.

Transition of Care Support for Patients and Caregivers

This brochure provides patients and caregivers with an overview of information and processes associated with Transition of Care Support for enrolled patients.

Patient Benefit Summary Glossary of Insurance Terms

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

SPECIALTY PHARMACY CALL REMINDER CARD

This card is to help patients remember to contact the specialty pharmacy 10 days from the date of prescription, if the specialty pharmacy has not been in touch with the patient.

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

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

To list your practice, to update your existing contact information, or to remove your listing, visit ListMyPractice.com.

LISTMYPRACTICE.COM

* This free tool provides a list of physicians, nurse practitioners, and physician assistants who have the required legal permissions to treat opioid dependence with FDA‑approved medications, have prescribed SUBLOCADE at least once in the previous two years, and have agreed to be included in the Indivior Find a SUBLOCADE Treatment Provider Tool.

The Substance Abuse and Mental Health Services Administration also provides information on treatment facilities at https://findtreatment.samhsa.gov/.