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Healthcare providers billing for drug services must consider the drug and dosage form that was provided to the patient, the patient's medical record, the coding requirements of each health insurer, and best coding practices. Billing and coding guidance provided under this heading does not provide a guarantee of reimbursement and should be considered together with all applicable guidance and standards.

Types of Assistance

Destination Access will assist patients who are seeking assistance to access one of the drugs that are included in this program.

Destination Access offers one form for both patient assistance and reimbursement.

For insured patients, assistance may include:

  • A benefits investigation to assist patients and healthcare providers to understand the patient's current drug coverage and the patient's out-of-pocket responsibility
  • Prior authorization assistance. Request prior authorization forms for prescribers to complete and submit to payers
  • Appeals assistance for denied prior authorizations or claims that have been denied coverage
    • Destination Access can help providers understand the cause of coverage denial and provide support in preparing claims and prior authorization for reconsideration by the health plan
  • Assistance accessing foundations and other organizations that provide help for health plan cost-sharing expenses (co-payments, deductibles, coinsurance, etc). This includes referral, assistance with application processes and follow-up with the foundation to ensure timely consideration of the patient's application
  • Education and referral information for the Low Income Subsidy (LIS) benefit to assist low-income Medicare Part D patients in obtaining extra help with their out-of-pocket healthcare costs for BMS Medicare Part D products
  • Help identifying sources of assistance for Medicare Part D enrollees who are unable to afford the program's premiums or cost-sharing expenses for BMS Medicare Part D products
  • Information about Medigap plans for patients who are unable to afford the cost of drugs that are covered by Medicare Part B
  • Identification of pharmacy providers that are contracted with the patient's health benefit plan, or that can provide medication at the lowest possible cost to the patient

For uninsured patients (including patients with insurance that does not cover drugs included in the Destination Access program), assistance may include:

  • A search for sources of insurance coverage or other funding that may assist the patient with the cost of healthcare services (eg, Medicare Part D, including the low-income subsidy benefit; Medicaid; Veteran's benefits; TriCare; state drug assistance programs)
  • Free Product Assistance through the Destination Access Patient Assistance Program is available to eligible uninsured patients, and to eligible insured patients who have been denied coverage by their insurer for a drug that is included in the Destination Access program, and to patients who have exceeded their insurance drug benefit maximum (usually the result of a monthly or annual pharmacy benefit cap)

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