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Coverage details clarified
Making sure your patients get the medication they need is the top priority, for you and for us. Our support is created with your patient’s need in mind. Tools are available to help you do the following:
- Navigate acquisition paths (e.g., medical benefit or pharmacy benefit)
- Confirm eligibility for financial support
- Guide through prior authorization requirements
- Information about process for claims submission and appeals
Obtaining BENLYSTA
Depending on the patient’s insurance, they may obtain BENLYSTA in different ways:
Patients can receive BENLYSTA directly from an in-network specialty pharmacy. Remind your patients that the specialty pharmacy will contact them to schedule delivery. If your patient is enrolled in the BENLYSTA Copay Program, please ensure they have their copay member information handy.
Under the patient’s medical benefit, you may be able to order and receive BENLYSTA from a specialty distributor. After treatment, submit claim to the patient’s insurance, collect copay from the patient if applicable, and for eligible patients, submit appropriate claim information to the BENLYSTA Copay Program.
With assignment of benefits, you can triage a prescription to a specialty pharmacy. Once approved by the patient’s insurance, the specialty pharmacy can ship BENLYSTA directly to your office for administration. The specialty pharmacy will contact the patient to collect any copay. If the patient is enrolled in the BENLYSTA Copay Program, the specialty pharmacy will collect copay member information.
See below for more information about each option.
Specialty pharmacy
Buy and bill
Assignment of benefit
Options for direct access support
If you only need specific services—such as verifying coverage or initiating prior authorizations—simply select an option below to quickly access the information you need.
GSK is a sponsor of the services provided by eBlu and CoverMyMeds. CoverMyMeds and eBlu are independent third parties. GSK is not responsible for the products and services provided. Prior authorization outcomes are not guaranteed. Approval of a prior authorization is up to the payer and is not a guarantee of payment.
Coverage information
Through the eBlu Solutions portal, you can access a patient’s coverage status, estimated cost share, prior authorization forms, and appeals status in one easy-to-read view. For more information, visit eblusolutions.com.
Registration with eBlu is required.
Prior authorization
CoverMyMeds is a no-cost solution to provide information about prior authorization requests for BENLYSTA.
Register at covermymeds.com or call 1-866-452-5017.
BENLYSTA: Billing and Coding Information
The following codes may be relevant when billing for BENLYSTA and its administration.
Access resources
CMS-1500 form
Use for services provided in physician office
CMS-1450 form
Use for services provided in hospital outpatient department
Sample letter of medical necessity
Offers guidance that may be helpful when establishing medical necessity
Sample appeal letter
Offers guidance that may be helpful when filing an appeal for a denied claim
These resources are provided for information purposes only; it is the responsibility of providers to complete these forms based upon their best clinical judgment and in accordance with the payer's process.
FOR IN-PERSON REIMBURSEMENT SUPPORT
Connect with an available Access & Reimbursement Manager (ARM)
They can provide general information on your patient’s:
- Coverage
- Prior authorization
- Billing & coding
- Affordability programs such as copay assistance
The information provided by the ARM is not a guarantee of coverage or reimbursement.