NextSource CARES Patient Advocates are available to assist you with all aspects of
claims processing, coverage, and payment for NextSource Biotechnology medications.
We are available to assist you with:
- Third-party payer coverage and deductible and co-payment information
- Insurance coverage and product-specific coverage verification and assistance to secure pre-certification
- Clarification of reimbursement and/or coverage restrictions or limitations
- Statement of medical necessity and/or prior authorization documentation requirements
- Appeals assistance for denied prior authorizations and/or denied or underpaid claims
Q: How can I determine if my prescription is covered by my patient’s health insurance plan?
A. To determine if the health insurance plan provides coverage and you are a healthcare professional, simply call the toll-free number for provider relations on the patient’s insurance card. Please have patient, product and clinical information readily accessible, as the payer representative will need this information to confirm coverage. If you are the patient, simply call the toll-free number for member services on the insurance card. If you desire assistance, please contact NextSource CARES at 855-457-8880.
Q: I contacted the health insurance company and they told me that I would need to have the physician submit prior authorization before coverage can be approved. How do I get a prior authorization?
A. To request a prior authorization, your prescribing physician will need to submit prior authorization information to the insurance company on a form, if required by the payer or a letter providing the clinical reasons why the product is medically necessary. Most prior authorizations are approved or denied within 24 to 72 hours. If you cannot get a prior authorization or desire assistance, please contact NextSource CARES at 855-457-8880.
Q: The health insurance plan denied coverage. What does that mean?
A. The health insurance plan may not know that the patient meets the medical necessity requirements for coverage. You may be required to submit detailed medical necessity and clinical information that confirms the medical need for the product. NextSource CARES may be able to provide assistance. Please contact a NextSource CARES Patient Advocate at 855-457-8880.
Q: My pharmacist told me that the drug on my prescription is not listed as a formulary drug and recommended an alternate drug. What does this mean?
A. Generally, a non-formulary prescription drug is available only after a prior authorization is submitted by the prescribing physician that documents the medical need for the product. Exceptions are granted if a physician can document that there are no other drugs available on the formulary to treat the condition, or that a drug listed on the formulary was tried but the drug failed to treat the condition effectively. NextSource CARES may be able to provide assistance. Please contact a NextSource CARES Patient Advocate at 855-457-8880.
Q: I do not have health insurance, nor do I qualify for government health insurance programs such as Medicare, Medicaid, VA, Military or Tricare. I cannot afford the cost of the product. Can you assist me?
A. You may qualify for assistance under the NextSource CARES Program Uninsured Patient Assistance Program. To be eligible, your doctor must have prescribed a NextSource Biotechnology drug; you must be a permanent, legal resident of the United States; you must NOT have prescription drug insurance coverage; you must NOT be 65 years of age or older and/or eligible for Medicare, Medicaid, or Veteran’s Administration benefits; your total GROSS YEARLY HOUSEHOLD INCOME (before deductions) is equal to or less than two (2) times the Federal Poverty Level. NextSource CARES may be able to provide assistance. Please contact a NextSource CARES Patient Advocate at 855-457-8880 or download and complete the NextSource CARES Patient Assistance Program application and follow the instructions for submission to the NextSource CARES program.