Case managers can provide information on financial assistance programs that may be available to your patient and help address hurdles that could delay starting their Takeda Oncology medication. For patients who may need immediate attention, expedited requests to their insurance provider stating their medical necessity may be needed. A downloadable Sample Letter of Medical Necessity is available here.
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Benefits investigation
Your patient’s case manager will conduct a benefits investigation within 2 business days of enrollment to determine if their insurance plan covers their medication.* They will provide a summary of coverage options, including information on:
- Out-of-pocket costs
- Exclusions
- Prior authorization and appeals processes
- Specialty pharmacies within your patient’s network
Prior authorizations
Your patient’s case manager will provide information on the payer prior authorization process and submission requirements for their insurance plan. We’ll keep you and the specialty pharmacy updated on the status and expirations of your patient’s prior authorization.
Payer denials†
If a denial of payment occurs, we can help explain the reasons for denial and provide information on the appeal process. Get started with the Sample Letter of Appeal template available here.
Download*Verification of benefits is not a guarantee of payment and does not take the place of written policy information. Healthcare providers should carry out their own benefits investigation, as necessary.
†Takeda Oncology Here2Assist® does not complete forms, or appeal denials of coverage on behalf of healthcare providers. It cannot guarantee success in overturning a payer denial.