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Specialty Pharmacy
Copay Assistance
INSUPPORT offers a Copay Assistance Program for eligible* patients

Copay Assistance for Eligible Patients

INSUPPORT™ offers a Copay Assistance Program designed to help eligible patients with the out-of-pocket costs for SUBLOCADE™ (buprenorphine extended-release) injection, for subcutaneous use (CIII).

Eligible patients pay a minimum of $5 per injection. Restrictions apply.

For more information on patient eligibility requirements and program details, please refer to the Terms and Conditions for the INSUPPORT™ Copay Assistance Program for SUBLOCADE.

Enrolling patients in the INSUPPORT Copay Assistance Program

If the patient is not yet enrolled in the INSUPPORT™ Copay Assistance Program for SUBLOCADE, enrolling in the program is simple. Note that patients participating in INSUPPORT™ Hub Services are automatically enrolled for copay assistance.

  1. Download the Patient Enrollment Form using the link below.
  2. Select "Apply for the Copay Assistance Program for SUBLOCADE" and complete the required steps, including the Provider Authorization signature. Please also ensure that the patient reads the Terms and Conditions and Patient Certification for the INSUPPORT™ Copay Assistance Program, signs, and dates the Patient Authorization and Consent page of the Form.
  3. Fax the completed form directly to INSUPPORT™ at 1-844-814-0669 or submit the form online.
Download the Patient Enrollment Form
English form Spanish form

This form is also available electronically on the INSUPPORT™ Provider Portal.

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


Once the patient is enrolled in the INSUPPORT Copay Assistance Program

INSUPPORT™ will provide the enrolling healthcare provider with the patient's Copay Member ID for submission of copay claims to INSUPPORT™, as well as copay claim submission instructions. If the patient is enrolled in the INSUPPORT™ Copay Assistance Program, the specialty pharmacy will receive the patient's Copay Member ID in the routing information from INSUPPORT™ to the specialty pharmacy. A Copay Member ID card will be provided to the patient in his/her welcome letter upon enrollment in the Program. The specialty pharmacy will contact the patient to collect the out-of-pocket costs or advise the patient of the cost, which will be billed following the appointment.

For more information, please refer to the Terms and Conditions for the INSUPPORT™ Copay Assistance Program for SUBLOCADE.

*Eligibility

The INSUPPORT™ Copay Assistance Program is valid ONLY for patients with private insurance who are prescribed SUBLOCADE for on-label use. Patients 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.

For more information, please refer to the Terms and Conditions for the INSUPPORT™ Copay Assistance Program for SUBLOCADE.

FAQs
Does a patient have to use the Copay Assistance Program?

No. The patient does not have to use the Copay Assistance Program in order to receive their SUBLOCADE prescription.

What do I need to do if I am not the enrolling healthcare provider for the patient?

You will need to work with the patient to complete the sections required to update a provider on their INSUPPORT™ Patient Enrollment Form. A signed and dated Patient Authorization and Consent Form as well as Provider Authorization Form are required for submission. Once the necessary documentation is received, INSUPPORT™ will provide you with the patient's Copay Member ID for submission of copay claims to INSUPPORT™, as well as copay claim submission instructions.

Why can't patients on Medicare, Medicaid, or other government funded health insurance plans receive copay assistance?

The Office of Inspector General for the US Department of Health and Human Services has stated that pharmaceutical manufacturers providing copay assistance to patients receiving government insurance is inconsistent with federal law. Since Medicare and Medicaid are federal programs, Indivior cannot provide copay assistance to those patients. Other resources may be available to assist Medicare and Medicaid patients.

Can the specialty pharmacy enroll the patient in the Copay Assistance Program?

No, the specialty pharmacy will need to refer the patient back to the healthcare provider for enrollment.