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Reimbursement Information

INSUPPORT® can provide information on the reimbursement process
Medical services reimbursement

Specialty pharmacies are typically responsible for billing the insurance provider for the cost of SUBLOCADE® (buprenorphine extended-release) injection, for subcutaneous use (CIII). The HCP office should only submit a claim to the insurance provider for the medical services.

Step 1: Submit the claim form

Following administration of SUBLOCADE to the patient, submit a claim to the patient's insurance provider. INSUPPORT® can provide you with billing and coding information.

Step 2: Reimbursement

If the claim is approved, the patient's insurance provider should make the payment to the HCP office.

Addressing claim denials

A: Identify the reason for the claim denial

If your claim is denied by the patient's insurance provider, you will be notified of the denial reason by the insurance provider.

Some of the common reasons for denial include:

  • Incomplete or inaccurate information
  • Lack of prior authorization
  • Diagnosis and procedure coding errors and omissions
  • Insufficient medical necessity

B: Fix any errors and provide additional documentation

If required, verify coding and other information provided is complete and accurate. You may also submit a Letter of Medical Necessity to the patient's insurance provider, if required by the insurer.

View Sample Letter of Medical Necessity

*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.

Have questions?

Receive information from a local Patient Access Specialist (PAS) regarding your access and reimbursement questions.

FIND A PAS IN YOUR AREA

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

FAQs

Do I need to complete the INSUPPORT® Patient Enrollment Form again to receive Appeals Information for a denied claim?

For patients already enrolled in "Benefit Coverage Information" with INSUPPORT®, appeals information can be provided, where applicable, and does not require a new enrollment. Please contact INSUPPORT® for more information.