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SUPPORT FROM NURSE CASE ADMINISTRATORS

Teva Support Solutions® is here to help provide support for you and your patients. Once Teva Support Solutions® receives the 1-page Prescription and Service Request Form, you will be assigned a Nurse Case Administrator who can help with all of the services listed below.

BENEFITS VERIFICATION

The Nurse Case Administrator will perform a thorough benefits verification. The process is initiated once the Prescription and Service Request Form is received. Once the benefits verification is finished, a Summary of Benefits will be faxed to your office and will include important information about your patients’ insurance coverage. We can also help you by notifying you if a reverification of your patients’ benefits is needed.

Additionally, the Nurse Case Administrator will reach out to your patients to discuss insurance coverage details and financial assistance options that may be available to them.

PRIOR AUTHORIZATION SUPPORT

By completing the benefits verification, the Nurse Case Administrator can also determine if a prior authorization is needed. If it is, a Prior Authorization Form may be included in the Summary of Benefits faxed to your office. This entire process is started by completing the Prescription and Service Request Form.

ADMINISTRATION LOCATION ASSISTANCE

A Nurse Case Administrator with Teva Support Solutions® can identify an in-network facility where your patients can receive treatment. Simply complete the Prescription and Service Request Form or call 1-844-838-2211 to get started.

SPECIALTY PHARMACY ACQUISITION

If you prefer to acquire CINQAIR® via a specialty pharmacy, or if a health plan requires acquisition of CINQAIR® by one or more specialty pharmacies under the Medical or Pharmacy Benefit, a Nurse Case Administrator at Teva Support Solutions® can help determine specialty pharmacy acquisition requirements.

To request confirmation of specialty pharmacy requirements, select Specialty Pharmacy as the preferred acquisition method on the Prescription and Service Request Form.

If the requirements are met, Teva Support Solutions® will refer your prescription to a specific specialty pharmacy accepted by your patient's health plan to fulfill and ship CINQAIR® to a site administration.

Note: The specialty pharmacy may contact your office to request additional information, including a request to re-send a CINQAIR® prescription directly to the specialty pharmacy.

APPEALS SUPPORT

If the insurance company has denied coverage for CINQAIR®, Teva Support Solutions®, available at 1-844-838-2211 Monday through Friday from 9 AM to 7 PM ET, may be able to help.

FINANCIAL ASSISTANCE

Your patients will be automatically enrolled when you submit a signed Prescription and Service Request Form to Teva Support Solutions®

Eligible patients will receive a CINQAIR Cost Support Program Card to pay their out-of-pocket costs for CINQAIR and administration at their treatment provider.

Patients should always bring their CINQAIR Cost Support Program Card to their treatment provider appointments.

* Persons residing in the states of Massachusetts, Minnesota, Michigan, and Rhode Island are eligible for financial assistance with their out-of-pocket costs for the drug only and are NOT eligible for other types of financial assistance (administration of the drug). See complete Terms and Conditions.

Patients with government insurance (Medicare, Medicaid, TRICARE) or patients who are uninsured:

Foundation support may be available for patients with government-funded insurance, or who are uninsured or underinsured who need help affording their medication. Patients can call Teva Support Solutions® to get connected to alternative funding options.

CODING, BILLING & CLAIMS SUPPORT

For reimbursement- or claims-related questions, contact a Nurse Case Administrator at 1-844-838-2211 Monday through Friday from 9 AM to 7 PM ET.

FOR PRODUCT INFORMATION FOR CINQAIR® (RESLIZUMAB) INJECTION, VISIT CINQAIR.COM