COMPLETING A PA
Some insurance providers may require a PA to grant a patient coverage for SUBLOCADE® (buprenorphine extended-release) injection, for subcutaneous use, CIII.
INSUPPORT can provide information on the PA process and/or PA requirements from a patient's insurance provider, when applicable. Regardless of whether patient information is provided from INSUPPORT or directly from a healthcare provider (HCP) office, the specialty pharmacy receiving the patient's prescription will verify the patient's benefits as part of their benefit investigation process, and will provide the insurance provider's PA requirements and/or forms to the HCP office, if applicable.
Step 1: Complete and submit required PA information
When a PA is required by the patient's insurance provider, the specialty pharmacy will contact the HCP office regarding the authorization submission process and required information.
The patient's healthcare provider must complete and submit the PA form(s) to the patient's insurance provider.
Once the required PA forms are submitted to the patient's insurance provider, the specialty pharmacy will check the status of the PA request until an outcome is determined by the patient's insurance provider.
INSUPPORT can provide contact information for network specialty pharmacies.
Step 2: Learn PA outcome
Once a coverage determination has been made, the patient's insurance provider will communicate the outcome of the PA request to the HCP office. The HCP may review the outcome to inform next steps.
Step 3: Communicate with the specialty pharmacy
If the PA is approved by the health insurance plan, the HCP may communicate the approval from the plan to the chosen specialty pharmacy. Once coverage is confirmed, the specialty pharmacy will contact the HCP to confirm the injection date and coordinate shipment of the medication.
FAQs
Do I have to renew a PA once the patient's health insurance plan has approved it?
Often, insurance providers require re-authorization for the patient after a certain period of time. If the patient is enrolled in "Benefit Coverage Information" with INSUPPORT, INSUPPORT will notify you 21 days in advance of expiry of the current authorization and provide re-authorization requirements communicated by the patient's insurance provider. If the patient is not enrolled in INSUPPORT, you may contact the patient's health insurance provider for information about re-authorization requirements.
Is there any additional information that the health insurance provider may require to determine a PA for the patient?
Each health insurance plan has its own PA requirements. If the patient is enrolled in "Benefit Coverage Information" with INSUPPORT, INSUPPORT will inform you of any requirements communicated by the patient's insurance provider on the Preliminary Benefit Summary. If the patient is not enrolled in INSUPPORT, you may contact the patient's health insurance provider for information about PA requirements.