Enrolling the patient in INSUPPORT
For patients who enroll in "Benefit Coverage Information" through INSUPPORT, INSUPPORT can conduct a benefit investigation of the patient's insurance coverage for SUBLOCADE® (buprenorphine extended-release) injection, for subcutaneous use, CIII, for the patient's current site of care. INSUPPORT can also provide information on the prior authorization and/or appeals requirements and confirm product acquisition requirements from the patients insurance provider.
For patients enrolled in "Transition of Care Support," INSUPPORT can help in the transition process by providing benefit coverage information and important dates to the new site of care, as well as text reminders to patients for upcoming dates with the new provider. Learn more about Transition of Care Support for your patients.
Getting started is simple. First select a tab to view steps for your preferred method of enrollment.
What is the INSUPPORT Portal?
The INSUPPORT Portal allows healthcare providers (HCPs) to electronically enroll patients in any program option offered by INSUPPORT. It also allows for Patient Authorization to be requested, completed and submitted by the patient to INSUPPORT via electronic signature.
Step 1: Go to the INSUPPORT Portal
Once on the portal, 1) select a product, 2) select healthcare provider as the user type, 3) enter the required HCP information, and 4) indicate the requested program option(s) for your patient. No registration is required to use the portal.
Go to INSUPPORT PortalStep 2: Complete the Patient Enrollment Form
Once you have selected the requested program option(s) for the patient, you must complete the required information fields in the enrollment form, including your electronic signature and date for the Provider Attestation. You will then be able to initiate a request via email to the patient for him/her to complete the Patient Authorization via electronic signature and submit it to INSUPPORT. Once the Patient Authorization is received from the patient, INSUPPORT will begin to process the enrollment request.
Need help completing the form? See an annotated sample form now*
Sample FormIf you require assistance in other languages, then please call INSUPPORT at 1-844-INSPPRT (1-844-467-7778).
Step 1: Complete the Patient Enrollment Form
On the INSUPPORT Patient Enrollment Form, select the patient's requested program option(s) and complete the required information. Please ensure all required fields are completed (marked with asterisk) and that the patient has reviewed, completed, signed and dated the Patient Authorization prior to submitting to INSUPPORT.
Download Patient Enrollment Form
English Form Spanish FormNeed help understanding the form? See an annotated sample form below*
Sample FormIf you require assistance in other languages, then please call INSUPPORT at 1-844-INSPPRT (1-844-467-7778).
Step 2: Submit the completed form to INSUPPORT
Once the required information has been completed, fax all pages of the completed form directly to INSUPPORT at 1-844-814-0669.
*This annotated sample is intended for informational purposes only and not for direct use as a Patient Enrollment Form.
Completing your own benefit investigation
You or your office staff can choose to conduct a benefit investigation yourself.
FAQs
Why is it necessary to obtain the patient's signature on the Patient Authorization Form?
INSUPPORT cannot take any action until Patient Authorization has been provided. In addition, INSUPPORT cannot contact the patient directly to obtain authorization. Any form with an incomplete Patient Authorization will be returned to the HCP for the patient to complete all required fields.
What if the patient's insurance provider does not provide coverage for SUBLOCADE?
If a medication is not covered by the patient's insurance provider or coverage is "Undetermined," there may be steps that you can take to request that the insurance provider re-evaluate the patient's coverage decision. You may contact the patient's insurance provider for more information.
Complete a Letter of Medical Necessity
You or your office staff may complete a Letter of Medical Necessity to provide further information about the patient and request coverage for SUBLOCADE.
View a Sample Letter of Medical Necessity†
Download Sample†This sample is intended for informational purposes only and not for direct use as a Letter of Medical Necessity.
Alternate Funding Information
INSUPPORT may also be able to provide contact information on potential alternate funding programs for which the patient may qualify. The patient will be responsible for contacting the programs to determine their eligibility and funds available, if applicable.
Information on potential alternate sources of funding is provided when there is no coverage reported for the medication from the patient's insurance provider.