Enrolling the patient in INSUPPORT
For patients who enroll in "Benefit Coverage Information" through INSUPPORT, INSUPPORT can conduct a benefit investigation of the patient's insurance coverage for SUBLOCADE® (buprenorphine extended-release) injection, for subcutaneous use, CIII, for the patient's current site of care. INSUPPORT can also provide information on the prior authorization and/or appeals requirements and confirm product acquisitions from the patients insurance provider.
For patients enrolled in "Transition of Care Support," INSUPPORT can help in the transition process by providing benefit coverage information and important dates to the new site of care, as well as text reminders to patients for upcoming dates with the new provider. Learn more about Transition of Care Support for your patients.
Getting started is simple. First select a tab to view steps for your preferred method of enrollment.
What is the INSUPPORT Portal?
The INSUPPORT Portal allows healthcare providers (HCPs) to electronically enroll patients in any program option offered by INSUPPORT. It also allows for Patient Authorization to be requested, completed and submitted by the patient to INSUPPORT via electronic signature.
Step 1: Go to the INSUPPORT Portal
Once on the portal, 1) select a product, 2) select healthcare provider (HCP) as the user type, 3) enter the required HCP information, and 4) indicate the requested program option(s) for your patient. No registration is required to use the portal.
Go to INSUPPORT PortalStep 2: Complete the Patient Enrollment Form
Once you have selected the requested program option(s) for the patient, you must complete the required information fields in the enrollment form, including your electronic signature and date for the Provider Attestation. You will then be able to initiate a request via email to the patient for him/her to complete the Patient Authorization via electronic signature and submit it to INSUPPORT. Once the Patient Authorization is received from the patient, INSUPPORT will begin to process the enrollment request.
Need help completing the form? See an annotated sample form below*
Sample FormIf you require assistance in other languages, then please call INSUPPORT at 1-844-INSPPRT (1-844-467-7778).
Step 1: Complete the Patient Enrollment Form
On the INSUPPORT Patient Enrollment Form, select the patient's requested program option(s) and complete the required information. Please note, if you plan to write a prescription for SUBLOCADE for your patient, you may choose to have INSUPPORT route the patient's information to a network specialty pharmacy on the enrollment form.
Please ensure all required fields are completed (marked with asterisk) and that the patient has reviewed, completed, signed and dated the Patient Authorization prior to submitting to INSUPPORT.
Download Patient Enrollment Form
English Form Spanish FormNeed help completing the form? See an annotated sample form below*
Sample FormStep 2: Submit the completed form to INSUPPORT
Once the form has been completed, fax it directly to INSUPPORT at 1-844-814-0669. Please ensure that the patient reviews, signs, and dates the Patient Authorization section of the enrollment form prior to submitting it to INSUPPORT.
Completing your own benefit investigation
Your office can choose to contact the patient's health insurance provider to conduct a benefit investigation yourself.
Review benefits and next steps
For patients enrolled in "Benefit Coverage Information," INSUPPORT will provide a Final Benefit Summary to the patient and healthcare provider (HCP) office, detailing the outcome of the benefit investigation. The document outlines the patient's benefit coverage information for SUBLOCADE and, if applicable, the patient's enrollment status in the INSUPPORT Copay Assistance Program. It will also indicate whether a prior authorization (PA) is required from a patient's insurance provider for a final coverage determination.
For patients enrolled in Transition of Care Support that have coverage for SUBLOCADE, INSUPPORT will provide a copy of the Final Benefit Summary for the new site of care to the enrolling HCP and the new treatment provider. The enrolling HCP will also receive an appointment confirmation sheet that can be returned to INSUPPORT if an appointment has been coordinated with the new treatment provider on behalf of the patient. If the patient has opted-in to text notifications, the patient can receive text reminders for an upcoming appointment or injection due date with the new provider.
Learn more about Transition of Care Support
View an Annotated Sample Final Benefit Summary from INSUPPORT*
Sample FormIf you requested for INSUPPORT to route your patient's information to a specialty pharmacy on the Enrollment Form, you will need to send the patient's SUBLOCADE prescription to the specialty pharmacy identified in the "Prescription Routing Information" section of the Final Benefit Summary in order to initiate the specialty pharmacy process.
If you did not request for INSUPPORT to route patient's information, INSUPPORT will notify you of any mandated or preferred network specialty pharmacies reported by the patient's insurance provider in the "Specialty Pharmacy Information" section of the Final Benefit Summary.
*These annotated samples are intended for informational purposes only and not for direct use as a Patient Enrollment Form or benefit summary.
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
Your office can choose to contact the patient's health insurance provider to conduct a benefit investigation yourself.
FAQs
Why is it necessary to obtain the patient's signature on the Patient Authorization Form?
INSUPPORT cannot take any action until Patient Authorization has been provided. In addition, INSUPPORT cannot contact the patient directly to obtain authorization. Any form with an incomplete Patient Authorization will be returned to the HCP for the patient to complete all required fields.
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 Sample†This sample is intended for informational purposes only and not for direct use as a Letter of Medical Necessity.
Alternate Funding Information
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.
Information on potential alternate sources of funding is provided when there is no coverage reported for the medication from the patient's insurance provider.
Does a new INSUPPORT Patient Enrollment Form have to be completed for a new prescription or for every refill from the specialty pharmacy?
No. INSUPPORT enrollment or a new benefit investigation is not necessary unless the patient's insurance has changed. Once the HCP has learned which network specialty pharmacy is preferred by the patient's insurance provider, the HCP can send the next prescription directly to that specialty pharmacy.