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Specialty Pharmacy
Benefit Investigation
INSUPPORT can help patients navigate insurance coverage issues

How to request a benefit investigation

Enrolling the patient with INSUPPORT

INSUPPORT™ can provide an overview of the patient's health insurance coverage for SUBLOCADE™ (buprenorphine extended-release) injection, for subcutaneous use (CIII), reimbursement support, and other information, as communicated through their health insurance provider. Patients enrolled in INSUPPORT™ Hub Services can receive detailed coverage information, including any potential restrictions, and/or the estimated medication costs to them. If Hub Services are requested, INSUPPORT™ will conduct a benefit investigation to determine the patient's coverage for SUBLOCADE and provide an estimate of out-of-pocket costs for the patient from their insurance provider. Getting started is simple. First select a tab to view steps for your preferred method of submission.

Step 1: Complete the Patient Enrollment Form

Once you download the Patient Enrollment Form, start by selecting which INSUPPORT™ service(s) are requested by the patient and complete the required information. Determination of eligibility for the INSUPPORT™ Copay Assistance Program for SUBLOCADE is included in INSUPPORT™ Hub Services or can be requested as a stand-alone service. To initiate a benefit investigation, select Hub Services on the form.

Ensure that the patient completes, signs, and dates the Patient Authorization and Consent section of the Patient Enrollment Form.

Download Patient Enrollment Form
English form Spanish form

Need help completing the form? See a sample form now

English form

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

Step 2: Submit the completed form to INSUPPORT

Once the required information has been completed, fax the signed and dated Patient Enrollment Form directly to INSUPPORT™ at 1-844-814-0669.

What is the INSUPPORT Provider Portal?

The INSUPPORT™ Provider Portal allows the HCP and staff to electronically enroll patients in the program. The portal provides real-time updates on patient case status and if applicable, copay activity for enrolled patients.

You can download a guide to help you use the Provider Portal.

Step 1: Log into the INSUPPORT Provider Portal

If the practice already has an account, sign in to begin the patient enrollment process.

If the practice has not yet registered for the INSUPPORT™ Provider Portal, sign up to create an account before proceeding.

Go to INSUPPORT™ Provider Portal

Step 2: Complete the Patient Enrollment Form

Start by selecting which INSUPPORT™ service(s) are requested by the patient and completing the required information. Determination of eligibility for the INSUPPORT™ Copay Assistance Program for SUBLOCADE is included in INSUPPORT™ Hub Services or can be requested as a stand-alone service.

Ensure that the patient completes, signs, and dates the Patient Authorization and Consent section of the Patient Enrollment Form.

Need help completing the form? See a sample form now

English form

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

Step 3: Submit the completed form to INSUPPORT

Electronically sign the provider authorization section as well as upload the signed and dated Patient Authorization and Consent page of the Patient Enrollment Form. Remember to have the patient read, sign, and date the Patient Authorization and Consent Form while in the office. If you are not able to complete enrollment once started, you can save a draft to finish at a later time.

Once the required information has been entered into the portal and the signed Patient Authorization and Consent Form has been uploaded, you can submit the patient's enrollment information to INSUPPORT™ for processing.

Going directly to a specialty pharmacy?

Specialty pharmacies verify benefits using their own process before dispensing a product to a patient, regardless of if benefits have been investigated by INSUPPORT™.

For HCPs who choose to refer patients directly to a specialty pharmacy, an intake form will need to be completed for the chosen network specialty pharmacy. The completed intake form may require signature(s) along with a valid prescription that must be faxed or e-prescribed to the specialty pharmacy to start the process.

INSUPPORT™ can provide the contact information for network specialty pharmacies.

Completing your own benefit investigation

You or your office staff can choose to conduct a benefit investigation yourself.

Information about how to conduct a benefit investigation

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How requesting a call from an INSUPPORT Case Manager can help patients

Patients can obtain a comprehensive review of their insurance coverage by requesting a call from a dedicated case manager when they enroll by selecting the option on the Patient Authorization and Consent Form. Requesting a Patient Benefit Summary call can allow patients to receive personalized assistance from their INSUPPORT™ Case Manager.

Have questions?

Receive information from a local Field Reimbursement Specialist (FRS) regarding your access and reimbursement questions.

FIND AN FRS IN YOUR AREA

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John Doe
INSUPPORT™ Field Reimbursement Specialist
Phone: 1 (888) 888-8888
FAQs
Why is it necessary to obtain the patient's signature on the Patient Authorization and Consent Form?

INSUPPORT™ cannot take any action until a written or electronic patient signature has been obtained. In addition, INSUPPORT™ cannot contact the patient directly to obtain authorization and consent. Any Patient Enrollment Form submitted without a signed and dated Patient Authorization and Consent, via fax or the INSUPPORT™ Provider Portal, will be returned to the HCP for the patient's signature and signature date.

Can a patient be enrolled in INSUPPORT services online?

A patient's healthcare provider can enroll a patient online by visiting the INSUPPORT™ Provider Portal and completing the required steps for enrollment for the requested services. A signed and dated Patient Authorization and Consent Form is required to be uploaded even when enrolling a patient in INSUPPORT™ services electronically via the INSUPPORT™ Provider Portal.

What if the patient's insurance provider does not provide coverage for SUBLOCADE?

If a medication is not covered by the patient's insurance provider or coverage is “Undetermined,” there may be steps that you can take to request that the insurance provider re-evaluate the patient's coverage decision. You may contact the patient's insurance provider for more information.

Complete a Letter of Medical Necessity

You or your office staff may complete a Letter of Medical Necessity to provide further information about the patient and request coverage for SUBLOCADE.

View a Sample Letter of Medical Necessity

DOWNLOAD PDF
Alternate Funding Research

INSUPPORT™ may also be able to provide contact information on potential alternate funding programs for which the patient may qualify. The patient will be responsible for contacting the programs to determine their eligibility and funds available, if applicable.

Alternate Funding Research is included as part of the benefit investigation for patients enrolled in INSUPPORT™ Hub Services or can be requested at any time as a stand-alone service by selecting “Alternate Funding Research” on page one of the Patient Enrollment Form.