Celgene Patient Support Specialist

REVLIMID®  is only available
through a restricted distribution program.
Please see full Prescribing Information,
including Boxed WARNINGS.

Insurance-related assistance for REVLIMID®

On behalf of the patient, our Specialists are available to assist with each of the following steps in the insurance approval process for REVLIMID*:

  • Initiate a benefits investigation to determine co-payment and other out-of-pocket costs for REVLIMID
  • Assess prior authorization or precertification requirements
  • Educate patients about insurance coverage or other programs for which they may qualify

If you need assistance with the prior authorization or precertification process or are following up on a prior authorization or precertification, Celgene Patient Support® can help.

  • We can assist with the prior authorization or precertification process, providing you with the necessary forms for completion
  • We can also follow up with the insurance provider to determine the outcome

If the patient’s insurance company denies a prior authorization, precertification, or claim for the prescribed REVLIMID, Celgene Patient Support® can provide:

  • Information about the appeals process after a denied prior authorization, precertification, and/or claim
  • A checklist of the required documentation for submission to the insurance company
  • An appeal submission to the insurance company at the request of the patient and follow up on the status until a decision is reached

In order for Celgene Patient Support® to assist with an appeal, please provide the following information within 2 weeks of the insurance denial:

  • Copies of the front and back of the patient’s health insurance card(s), including a drug card or copy of patient’s information sheet clearly identifying insurance information, including phone numbers and claim submission address
  • Denial letter from payer
  • History and physical or consult letter and progress notes; and if applicable, related laboratory tests. Last 3 months needed
  • Letter of medical necessity; please include drugs tried and failed for this diagnosis. You can download information for letter of medical necessity here
  • Appointment of representative release form. This form allows us to assist the patient with the appeals process and can be downloaded here

REVLIMID is available exclusively through a select network of pharmacies due to restricted distribution programs. Your Celgene Patient Support® Specialist can provide information on which pharmacy is in network with each patient’s insurer.

You can access the REMS Pharmacy Network List online at www.celgene.com/patients/rems-pharmacy-network.

Fast Track For First PrescriptionFast Track helps eligible patients receive their first prescription faster Learn more >

 

*Celgene cannot provide insurance advice or make insurance decisions.
Celgene provides a facilitation service and will not provide any medical input into a prior authorization or an appeal.