SPRYCEL® (dasatinib) Prior Authorization Process
Destination Access is designed to help patients with reimbursement needs regarding SPRYCEL, such as benefit investigations, a Prior Authorization, or appeals assistance.
A Prior Authorization is used by many commercial and other health insurers, as well as managed care organizations (including Medicare Advantage Plans), to determine medical necessity for a healthcare service prior to the time claims are considered for coverage. When Prior Authorization is pursued prior to the time a service is rendered, it helps ensure that the patient understands coverage for the service before a financial obligation to the provider may be incurred. Health insurers may require a Prior Authorization as part of their SPRYCEL coverage policy.
Obtaining prior authorization: a step-by-step overview
If a Prior Authorization is denied, Destination Access can help determine the next steps and provide the clinic with the necessary information and tools to appeal the denial. Each commercial insurer may have different requirements and timelines for processing a Prior Authorization and appeal.
The NDC numbers for SPRYCEL®:
20mg = 00003-0527-11 60 tablets per bottle
50mg = 00003-0528-11 60 tablets per bottle
70mg = 00003-0524-11 60 tablets per bottle
100mg = 00003-0852-22 30 tablets per bottle
The following algorithm illustrates the prior authorization process for SPRYCEL. Health insurers may require specific forms and supporting documents (eg, history and physicals, pathology reports) for prior authorization.
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