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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
- Confirm eligibility for financial support
- Guide through prior authorization requirements
- Information about process for claims submission and appeals
Obtaining EXDENSUR
How and where your patient receives their dose of EXDENSUR may depend on decisions made by the patient and you. Be sure to review the patient's insurance benefits, preferences, and any requirements to determine whether EXDENSUR will be administered in your office or at an alternate site of care.
For administration in your office, EXDENSUR can be purchased through a specialty distributor or shipped to you through a specialty pharmacy.
Here’s what to expect:
- Verify the patient’s insurance coverage and benefits.
- Obtain EXDENSUR as described above.
- Administer EXDENSUR during the visit and manage any follow-up care.
- Collect copay from the patient if applicable and, for eligible patients, submit appropriate claim information to the EXDENSUR Copay Program.
You and your patient may decide to have EXDENSUR administered at an alternate site of care (ASOC). Use the locator tool below to find an ASOC at a location convenient to you and the patient.
Here’s what to expect:
- Identify an ASOC that can provide EXDENSUR for your patient.
- Work with the selected ASOC to ensure that appropriate referral information is provided.
- If eligible, patients may use their EXDENSUR copay card at an ASOC.
- Confirm treatment and monitor your patient's response.
Additional information on obtaining EXDENSUR
EXDENSUR: Billing and Coding Information
The following codes may be relevant when billing for EXDENSUR and its administration.
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.
Additional resources
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.
Coverage information
Need help verifying coverage? Through eBlu Solutions, your office can perform electronic real-time benefit investigation and submit prior authorizations.
Prior authorization
CoverMyMeds is a no-cost solution to provide information about prior authorization requests for EXDENSUR.
GSK is a sponsor of the services provided by eBlu and CoverMyMeds. eBlu and CoverMyMeds 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.
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