access and 
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Together, we got this

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.

HyQvia is covered similarly to other treatments for PI, but requirements may vary by plan.

The first questions patients may have are whether their health insurance covers HyQvia and how much it will cost.

Benefits investigation

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.

Download the Dual Benefit Brochure

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.

 

 

Coverage Lookup Tool

Use this lookup tool to determine your patient’s coverage information for HyQvia in your area.
Search for local coverage by entering a ZIP code.

Review safety information

Review Important Safety Information, including Contraindications and other specific Warnings and Precautions to consider when prescribing and monitoring patients treated with HyQvia.

Clarify a health plan's prior authorization requirements and prevent any treatment access delays

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.

Appeals process

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:

  • Missing or inaccurate information 
  • Step-edit requirement 
  • Incorrect diagnosis code(s) submitted 
  • Billed to the wrong benefit (ie, medical vs pharmacy) 
  • Site of care for infusion is not preferred/not covered 
  • Not covered on the formulary 

These resources are at your disposal to assist the prior authorization process for HyQvia

PA Checklist

Be prepared for every PA submission

Denials and Appeals Resource

Understand the appeals and denials process for both pharmacy and medical benefits

Appeals Checklist

Appealing a denial requires organized paperwork and information

Sample Letter of Medical Necessity (LMN)

An LMN supports the PA process by explaining the clinical rationale for HyQvia

Sample Letter of Appeal

Each appeal needs to clearly answer the reason for denial and the HCP’s clinical rationale

HyQvia Prescribing Information

Please click for Full Prescribing Information, including Black Box Warning

Takeda Patient Support* Co-Pay Assistance Program

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.

Eligibility*:

  • Be prescribed HyQvia for primary immunodeficiency (PI) 
  • Have commercial insurance This includes Health Insurance Marketplace plans

See below for terms and conditions.

 

If your patient has government insurance, Takeda Patient Support can help answer questions about their prescribed Takeda treatment coverage. This includes federal or state insurance such as Medicare, Medicare Advantage, or Medicaid.

If your patient can’t afford treatment, Takeda Patient Support may be able to connect them to programs that may help.

Enroll patients today

Complete the Start Form and fax to 1-866-861-1752.

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.

Billing & Coding Guide.

HyQvia Billing and Coding Guide

HyQvia is covered by many insurers for the treatment of patients with primary immunodeficiency disease. This guide contains common administrative and diagnosis codes related to HyQvia.

The codes are provided for informational purposes and may not include all necessary codes.

CMS-1500 Claim Form.

CMS-1500 Claim Form

The CMS-1500 claim form is the standard claim form used to bill many government and private insurers. This sample is intended to assist you with completing the form for billing HyQvia and associated services.

HelloHyQvia Free Trial Program

Learn if HyQvia is right for your patients with the HelloHyQvia Free Trial Program 

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. 

1

Download and complete

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 

  • Please note, the pharmacist will call the HCP’s office to clarify ramp-up dosing if it is not written or the box isn’t checked 

2

Receive a welcome call

Patient will receive a welcome call from a HelloHyQvia Free Trial Case Manager.

The Case Manager will:

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

3

Receive HyQvia infusions

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 can play an important role in chronic disease management

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. 

Peristaltic infusion pump

How to infuse HyQvia with a peristaltic pump.

Patient experience videos

See how real HyQvia patients, Mary and Michael, infuse HyQvia.

Find comprehensive resources that provide support for your patients.

Explore comprehensive resources for your patients to help support them with their HyQvia treatment.

Why HyQvia brochure.

Why HyQvia brochure

Helps patients learn if HyQvia is right for them, while encouraging them to take the next step in their treatment journey.

Patient Starter Kit.

Patient Starter Kit

The HyQvia Patient Starter Kit contains educational resources and materials to help facilitate their PI treatment. 

To order starter kits, contact your specialty pharmacy. 

Step-by-Step Infusion Guide.

Step-by-Step Infusion Guide

If your patient needs to learn how to infuse HyQvia using a peristaltic infusion pump, this step-by-step guide helps you walk them through all the necessary steps. 

How to Infuse HYQVIA with a Syringe Driver Pump Guide.

How to Infuse HyQvia with a Syringe Driver Pump

After you’ve ensured your patient is properly trained on how to administer their medication with a syringe driver pump, pass this guide along to help reinforce what they’ve learned. 

Support from the start with resources throughout their journey

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:

  • Learn more about PI and managing their condition
  • Sign up to receive educational materials that can help them and their loved ones better understand PI
  • Connect by phone or online with patient advocates that have PI or have loved ones living with the condition
  • Register for events focusing on disease education related to PI

Have your patients connect at MyIgSource.com or call 1-855-250-5111.

Get answers to your questions. Talk to a representative about HyQvia.

Welcome to Takeda Patient Support

When your patient enrolls, we’re here to help them gain access to their prescribed Takeda medication. Our dedicated specialists provide several services, including:

  • Benefits investigation to help determine your patient’s insurance benefits
  • Prior authorization (PA), reauthorization, and appeals information in coordination with your patient’s insurance company to determine any requirements
  • Financial assistance options including the Takeda Patient Support Co-Pay Assistance Program. The program may cover up to 100% of your patient’s out-of-pocket co-pay costs, if they’re eligible*
  • Education and training about their prescribed Takeda treatment or condition from nursing professionals. Our nurses cannot provide medical advice
  • Specialty pharmacy triage, coordination, and more

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.

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.

Reference

  1. HyQvia. Prescribing information. Takeda Pharmaceuticals U.S.A., Inc.; 2023.