access and
support
access and
support
Your patient with primary immunodeficiency (PI) may have questions regarding cost and coverage.
In this section, we have several educational resources to help you help your patient along the insurance journey.
The first questions patients may have are whether their health insurance covers HyQvia and how much it will cost.
A benefits investigation can uncover these answers. Call the patient’s health plan on their behalf to determine coverage and out-of-pocket costs. Be sure to have your patient’s full insurance information to get the process started.
There are some health plans that cover HyQvia under the medical benefit, the pharmacy benefit, or both. This dual benefit design can impact how HyQvia is acquired and reimbursed.
A basic overview and comparison of the 2 benefit designs is detailed here.
Depending on a patient's medical and prescription drug benefit, you may be required to submit a prior authorization (PA) before your patient can receive treatment with HyQvia. Each health plan has different requirements, so it's always good to call and confirm their policy.
Sometimes PAs do get denied. You and your patient are able to appeal the decision and it's important to understand why it was denied in the first place. Some common reasons for denial:
If a patient is prescribed HyQvia and needs co-pay assistance, you can direct the patient to enroll in the Takeda Patient Support Co-Pay Assistance Program. The program can cover up to 100% of your patient’s out-of-pocket co-pay costs, if they’re eligible.*† A support specialist can review your patient's coverage and determine eligibility.
Need to enroll your patient? Visit our convenient online enrollment portal at TakedaPatientSupport.com/HCP/HyQvia/Enroll_Your_Patient. You can also enroll your patient by faxing the completed Start Form to 1-866-861-1752.
*Must meet eligibility requirements.
†IMPORTANT NOTICE: The Takeda Patient Support Co-Pay Assistance Program (the Program) is not valid for prescriptions eligible to be reimbursed, in whole or in part, by Medicaid, Medicare (including Medicare Part D), Tricare, Medigap, VA, DoD, or other federal or state programs (including any medical or state prescription drug assistance programs). No claim for reimbursement of the out-of-pocket expense amount covered by the Program shall be submitted to any third party payer, whether public or private. The Program cannot be combined with any other rebate/coupon, free trial, or similar offer. Copayment assistance under the Program is not transferable. The Program only applies in the United States, including Puerto Rico and other U.S. territories, and does not apply where prohibited by law, taxed, or restricted. This does not constitute health insurance. Void where use is prohibited by your patient’s insurance provider. If your patient’s insurance situation changes, they must notify the Program immediately at [1-855-268-1825]. Coverage of certain administration charges will not apply for patients residing in states where it is prohibited by law. Takeda reserves the right to rescind, revoke, or amend the Program at any time without notice.
HyQvia offers helpful resources so that your office can sort through the complexities of the reimbursement process. Find downloadable resources and information needed to process billing and diagnostic codes and claim forms.
Help your eligible* patients with primary immunodeficiency (PI) see if HyQvia is right for them. With the HelloHyQvia program, the entire cost of their first 3 infusions of HyQvia during the ramp-up period, along with ancillary supplies, pump, and administration, are all covered.
Get your eligible patients started today by following the process below.
Download and complete the HelloHyQvia Free Trial Request Form (see link below) and fax to 1-833-388-5467
Healthcare provider (HCP) can check a box on the form if they want to have the pharmacist determine ramp-up dosing
Patient will receive a welcome call from a HelloHyQvia Free Trial Case Manager.
Ensure that the patient has signed the HelloHyQvia Free Trial Request Form
Connect the patient with the specialty pharmacy that will coordinate medication shipment
Connect the patient with a nurse who will help schedule administration training
The patient will receive their first 3 ramp-up HyQvia infusions either at home or in the office, depending on what you choose. After completion of the program, communication will be sent to the physician documenting the infusion rate and patient experience.
*Eligible patients must have an ICD-10 code verifying diagnosis of PI, be a new patient not currently using HyQvia, and not have previously enrolled in the HelloHyQvia Program. Additional terms apply.
Patient education is a vital component in caring for patients with chronic disease because it informs and involves patients in understanding both the disease state and the care instructions necessary for their condition. It also helps patients understand any lifestyle changes that they will need to make to help manage their condition. You can support your patients with the following resources.
Explore comprehensive resources for your patients to help support them with their HyQvia treatment.
Find a strong support community and education resources for your patients with primary immunodeficiency, regardless of treatment.
MyIgSource is committed to helping your patients manage a life with primary immunodeficiency (PI) at diagnosis and throughout their PI journey. From advocacy to learning about diagnosis, management, and living with PI, your patients and their caregivers, regardless of treatment, have access to:
Have your patients connect at MyIgSource.com or call 1-855-250-5111.
When your patient enrolls, we’re here to help them gain access to their prescribed Takeda medication. Our dedicated specialists provide several services, including:
If English is not your patient’s preferred language, we can assist them in a language of their choosing.
*If your patients’ medication is dispensed by specialty pharmacy.
*Must meet eligibility requirements. †IMPORTANT NOTICE: The Takeda Patient Support Co-Pay Assistance Program (the Program) is not valid for prescriptions eligible to be reimbursed, in whole or in part, by Medicaid, Medicare (including Medicare Part D), Tricare, Medigap, VA, DoD, or other federal or state programs (including any medical or state prescription drug assistance programs). No claim for reimbursement of the out-ofpocket expense amount covered by the Program shall be submitted to any third party payer, whether public or private. The Program cannot be combined with any other rebate/coupon, free trial, or similar offer. Copayment assistance under the Program is not transferable. The Program only applies in the United States, including Puerto Rico and other U.S. territories, and does not apply where prohibited by law, taxed, or restricted. This does not constitute health insurance. Void where use is prohibited by your patient’s insurance provider. If your patient’s insurance situation changes, they must notify the Program immediately at 1-866-861-1750. Coverage of certain administration charges will not apply for patients residing in states where it is prohibited by law. Takeda reserves the right to rescind, revoke, or amend the Program at any time without notice.
‡If your patients’ medication is dispensed by specialty pharmacy.
Reference