Resources and Services to Help Meet Patient Access Needs
BENLYSTA Gateway is a program that helps patients and healthcare professionals understand access, distribution, and reimbursement for BENLYSTA.
1-877-4-BENLYSTA (1-877-423-6597) Monday to Friday, 8 AM to 8 PM, ET
Select option 1 for BENLYSTA Gateway
BENLYSTA Gateway
The Gateway is here to:
- Help your patients understand their insurance coverage for BENLYSTA
- Enroll your patients in the Co-pay Program* or PAP if they are eligible
Services include:
- Benefits verification and prior authorization research
- Prior authorization follow-up and appeal support
- Co-pay Program
- Specialty pharmacy (SP) triage
- Patient Assistance Program (PAP)
- Claims and billing support
* See terms and conditions for additional information.
BENLYSTA Cares is an optional program that offers your patients disease-specific education, patient support services, and other communication to support them on their treatment journey.
1-877-4-BENLYSTA (1-877-423-6597) Monday to Friday, 8 AM to 8 PM ET
Injection support & training
- Refresher injection support by phone
- Nurses* available by phone for ongoing injection support
- Step-by-step Instruction Video
Information & tools
Patients can call to request the following free items:
- Personalized communications: Patients receive tips, ideas, and info about what to expect as they get started on BENLYSTA and support to stay motivated as they continue
- Carrying case
- Sharps disposal container
* Nurses from BENLYSTA Cares do not give medical advice and will direct patients to their healthcare provider for any disease-, treatment-, or referral-related questions. Nurses from BENLYSTA Cares are available by phone Monday to Friday, 8 AM to 8 PM ET. If calling after hours, patients may leave a message and a nurse will return their call within 30 minutes.
Ordering BENLYSTA
BENLYSTA is available through a variety of options.
BENEFITS INVESTIGATION AND PRIOR AUTHORIZATION (PA) RESEARCH AND SUPPORT
BENLYSTA Gateway can complete a patient-specific benefits investigation with the patient's payer† and provide PA research and support.
For benefits investigation, BENLYSTA Gateway can:
- Contact insurance companies to obtain specific coverage information
- Determine whether payer requires prior authorization
- Determine estimated patient out-of-pocket responsibility
Once BENLYSTA Gateway completes a benefit verification, you and your patient will receive a Summary of Benefits that will review the patient's coverage. The information provided by the Gateway is not a guarantee of coverage. Providers should confirm coverage information with payers.
For PA research and support, BENLYSTA Gateway can:
- Research plan requirements
- Outline steps required for obtaining a PA from the patient’s plan
- Obtain unique and plan-specific PA forms (where applicable)
BENLYSTA Gateway can also follow up with the plan to help determine the status of the PA submission (if requested).
Remember, BENLYSTA Gateway cannot complete PA forms or submit related information to plans. Instead, it is the responsibility of the office and prescribing physician to provide the plan with patient-specific clinical documentation.
BENLYSTA CO-PAY PROGRAM
Patients may pay as little as $0 for BENLYSTA.*
The BENLYSTA Co-Pay Program helps eligible commercially insured patients with their out-of-pocket costs for BENLYSTA up to $15,000 for 12 months.
*Eligibility for the BENLYSTA Co-Pay Program must be determined by the GSK Co-Pay Program. Eligibility restrictions and program maximums apply. Visit www.GSKCopayProgram.com for complete Program Terms and Conditions.
Learn more about the Co-pay Program
BENLYSTA Gateway can also provide general information about coverage and out-of-pocket costs through completion of a benefit investigation on behalf of the patient (see section above).
BILLING AND CODING SUPPORT
Physician office
BENLYSTA Gateway can provide information about relevant codes for BENLYSTA, including product codes, procedure codes, NDC numbers, and revenue codes.
Hospital outpatient department
As with coding for services performed in the physician’s office, coding preferences and requirements in the hospital outpatient setting are dependent on payer type and plan type. BENLYSTA Gateway can help identify coding requirements in both settings.
Appeals research support
If a patient is denied coverage for BENLYSTA, BENLYSTA Gateway is available to research instances of coverage denial and identify steps practices can take to appeal claims. BENLYSTA Gateway cannot author appeal letters on behalf of physicians. See sample letter of appeal below.
Sample forms and letters
When BENLYSTA is accessed throughout the patient treatment journey, a practice or hospital outpatient department may encounter the need for information on Centers for Medicare & Medicaid Services (CMS) Claim Form 1500, as well as appeal letters and letters of medical necessity. Details and examples of each are provided below.
Additional Resources
