Appeals

If your patient's insurance company denies a prior authorization for the Celgene medication you have prescribed, Celgene Patient Support^® can help facilitate the appeal. Together, we will simplify and expedite the appeals process. We will exhaust all options available to your patients.

In order for Celgene Patient Support^® to assist with the appeal, please provide the following information within two weeks of the insurance denial:

• Copies of the front and back of the patient's health insurance card(s), including the patient's drug card or copy of patient's information sheet clearly identifying insurance information, including phone numbers and claim submission address
• Denial letter from payer. Complete with appeal address
• History and Physical or consult letter and progress notes, and if applicable, related laboratory reports. Last 3 months needed
• Letter of Medical Necessity (see below for guidelines). Please include drugs tried and failed for this diagnosis
• Appointment of Representative Release Form signed by the patient, parent or guardian. This form allows us to act on behalf of the patient during the appeals process. Click here to download this form.

At your patient's request, you will be informed in writing of the outcome of the appeal, including notification of any source of funding or coverage identified through the appeal process.

Letter of Medical Necessity
In seeking an appeal from your patient's insurance company, your Letter of Medical Necessity will be critical to the appeal outcome. Please consider whether your letter covers the following points:

• Brief history of the patient, including:
  • Patient name
  • Initial date of diagnosis
  • Significant laboratory tests and results
  • Specific cell type per pathology report, including documentation of metastasis, if applicable
  • Original treatment rendered, including all drugs, dosages and schedules
  • Reason for stopping treatment and the patient's clinical response
• Current status of patient, including:
  • Date of recurrence, if applicable
  • Recommended treatment plan with specific drugs, dosages and schedules
  • Rationale for treatment, including unabridged reprints or copies of applicable scientific and medical articles, comprehensive bibliographies, drug official FDA labeling, etc
  • Previous drug therapy, including status of specific lifetime maximum drug benefits and/or medical complications resulting from other drug treatment regimens

Should you have any questions regarding the appeal process, please contact your Celgene Patient Support^® Specialist at 1-800-931-8691.

Your Celgene Patient Support^® Specialist is a dedicated, central point of contact who will work with you to resolve access issues to Celgene medications. Contact us at 1-800-931-8691 for assistance.