Resources and Services to Help Meet Patient Access Needs

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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

www.benlystagatewayonline.com

DOWNLOAD BENLYSTA GATEWAY ENROLLMENT FORM

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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

* For commercially insured patients, see terms and conditions for additional information.

Benlysta Cares

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

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Injection support & training

  • Refresher injection support by phone
  • Nurses* available by phone for ongoing injection support
  • Step-by-step Instruction Video
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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.

Additional In-Office Resources

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How to Order Guide

List of distributors and specialty pharmacies that work with BENLYSTA.

Download

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BENLYSTA Gateway Brochure

Download

Ordering BENLYSTA

BENLYSTA is available through a variety of options.

  • Ordering BENLYSTA

    1. Specialty Distributor:

    Clinics can contact one of the approved specialty distributors below.

    • ASD Specialty Healthcare 1-800-746-6273
    • Besse Medical 1-877-728-3476
    • Cardinal Health Specialty 1-866-476-1340
    • CuraScript 1-877-599-7748
    • McKesson Specialty 1-800-482-6700
    • McKesson Plasma and Biologics 1-877-625-2566
    • Metro Medical 1-800-768-2002
    • Oncology Supply 1-800-633-7555

    2. Wholesaler:

    All GSK-authorized wholesalers are eligible to access BENLYSTA provided they service eligible customer classes of trade.

  • Acquisition through specialty pharmacies

    In-network Specialty Pharmacies include:

    • Acro Pharmaceutical Services 1-800-906-7798
    • AcariaHealth 1-800-511-5144
    • Accredo Health Group, Inc. 1-877-ACCREDO (1-877-222-7336)
    • Aetna SP Specialty Pharmacy 1-866-782-2779
    • AllianceRx Walgreens-Prime 1-888-347-3416
    • Amber Pharmacy 1-888-370-1724
    • Avella 1-877-546-5779
    • BriovaRx (affiliate of OptumRx) 1-855-427-4682
    • Cigna Specialty Pharmacy 1-800-351-3606
    • Commcare Specialty Pharmacy 1-888-203-7973
    • CVS Specialty Pharmacy 1-800-237-2767
    • Diplomat 1-877-977-9118
    • Exactus Pharmacy Solutions (Wellcare) 1-866-458-9246
    • For Humana Pharmacy, Inc. (Humana) 1-800-486-2668
    • Hy-Vee Pharmacy Solutions 1-877-RxHyVee (1-877-794-9833)
    • Kroger Specialty Pharmacy LA, LLC 1-888-355-4191
    • Magellan Rx Pharmacy 1-866-554-2673 – Florida; 1-800-350-8119 – New York
    • Meijer Specialty Pharmacy/RxBiotech 1-855-263-4537
    • Navarro Health Services (affiliate of CVS) 1-855-647-7979
    • Reliance Rx (Independent Health) 1-800-809-4763
    • SenderraRx 1-855-460-7928
    • US Bioservices 1-888-518-7246

    Specialty pharmacy providers:

    BENLYSTA is available from the specialty pharmacies listed above. The payer may require that the patient use a particular specialty pharmacy. Contact the payer for information about preferred or mandated specialty pharmacies.

    In addition, the BENLYSTA Gateway may be able to provide information about the payer’s requirements.

    If BENLYSTA is acquired through the Specialty Pharmacy, BENLYSTA Gateway can work with the Specialty Pharmacy by

    • Triaging prescription to in-network Specialty Pharmacy
    • Triaging co-pay information to the Specialty Pharmacy
    • Working with Specialty Pharmacies to provide status of enrolled patients

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.

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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.

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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.

GSK CO-PAY PROGRAM ELIGIBILITY

BENLYSTA Gateway can evaluate eligibility for the BENLYSTA Co-pay Program. Approved patients may pay as little as $0 for BENLYSTA. Up to program maximum of $15,000.

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Who may be eligible?

Your patients may be eligible for the program if they:

  • Have a commercial medical or prescription insurance plan
  • Are not insured
  • Are a resident of the US (including the District of Columbia, Puerto Rico, and the US Virgin Islands)
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Who is NOT eligible?

Your patients are not eligible for the program if they are:

  • Eligible for Medicare or have a state-funded or federal government-funded medical or prescription insurance plan such as Medicare, Medicaid, VA, or TRICARE
  • Age 65 or older (patients are considered eligible for Medicare and therefore not eligible for the Co-pay Program)
  • Enrolled in a commercial health plan that does not permit the use of co-pay assistance programs

BENLYSTA Gateway can help eligible uninsured patients and some Medicare patients who meet eligibility requirements obtain access to BENLYSTA free of charge through GSK's Patient Assistance Program.

 

In-network Specialty Pharmacy may initiate co-pay application by patient request with BENLYSTA Gateway.

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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).

BENLYSTA Copay Program

‡ The BENLYSTA Gateway Co-pay Program helps eligible approved patients with their out-of-pocket costs for BENLYSTA up to $15,000 for 12 months. Medicare-eligible patients and patients enrolled in government-funded programs are not eligible for the BENLYSTA Co-pay Program. Patients must submit a BENLYSTA Gateway Enrollment Form or complete an application online at BENLYSTAcopayprogram.com to determine eligibility. For full Program Terms & Conditions, please visit here

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.

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Sample Letter of Medical Necessity

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Sample Letter of Appeal

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Benlysta Cares

is here for your patients from the start