Navigating access and reimbursement. Together.
If patients need access or reimbursement support for their prescribed Pfizer Oncology medications, we’re here to help.
Insurance Support
BENEFITS VERIFICATION
We can conduct a benefits verification to determine a patient’s health insurance coverage and out-of-pocket costs.
PRIOR AUTHORIZATION (PA) ASSISTANCE
We’ll coordinate with a patient’s insurer to determine the PA requirements, where and how to submit requests, and typical turnaround times. After your office submits a PA request, we’ll follow up with the insurer on behalf of the patient to track the progress until a final outcome is determined.
APPEALS ASSISTANCE
If a patient’s claim is denied, we can review the reason why and provide information on payer requirements. After your office submits an appeal, we’ll follow up with the payer to track its progress until a final outcome is determined.
ONLINE SUPPORT
Log in to our provider portal to complete and submit an online enrollment form, to track the status of patient cases, and for secure messaging with Pfizer Oncology Together.
Product Distribution
To help your patients access the medication you’ve prescribed, we can identify specialty pharmacy options. If you prefer, you and your staff can also continue to work directly with specialty pharmacies.
BESPONSA® (inotuzumab ozogamicin) and MYLOTARG™ (gemtuzumab ozogamicin) are available through a network of specialty distributors and specialty pharmacies.
Injectable biosimilars are available through most major wholesalers.
VIEW SPECIALTY PHARMACIES & DISTRIBUTORS
Billing and Coding Assistance
For your patient claims submissions, we provide easy access to sample forms and template letters, along with billing and coding information for physician’s office and hospital outpatient settings of care.*
BESPONSA® (inotuzumab ozogamicin) & MYLOTARGTM (gemtuzumab ozogamicin)
- BESPONSA SAMPLE UB-04/CMS-1450 FORM FOR HOSPITAL OUTPATIENT USE
- BESPONSA SAMPLE CMS-1500 FORM FOR PHYSICIAN OFFICE USE
- MYLOTARG SAMPLE UB-04/CMS-1450 FORM FOR HOSPITAL OUTPATIENT USE
- MYLOTARG SAMPLE CMS-1500 FORM FOR PHYSICIAN OFFICE USE
BIOSIMILARS: ZIRABEVTM (bevacizumab-bvzr), RUXIENCETM (rituximab-pvvr), TRAZIMERATM (trastuzumab-qyyp), RETACRIT® (epoetin alfa-epbx) , & NIVESTYM® (filgrastim-aafi)
- ZIRABEV BILLING & CODING GUIDE
- RUXIENCE BILLING & CODING GUIDE
- TRAZIMERA BILLING & CODING GUIDE
- RETACRIT BILLING & CODING GUIDE
- NIVESTYM BILLING & CODING GUIDE
Please see full Prescribing Information for BESPONSA, including BOXED WARNING, or visit BESPONSAhcp.com.
Please see full Prescribing Information for MYLOTARG, including BOXED WARNING, or visit MYLOTARGhcp.com.
Please see full Prescribing Information for RUXIENCE, including BOXED WARNING and Medication Guide, or visit RUXIENCEhcp.com.
Please see full Prescribing Information for TRAZIMERA, including BOXED WARNING, or visit TRAZIMERAhcp.com.
Please see full Prescribing Information for RETACRIT, including BOXED WARNING and Medication Guide, or visit RETACRIThcp.com.
*The information provided here is intended for informational purposes only, and is not a comprehensive description of potential coding requirements for BESPONSA, MYLOTARG, ZIRABEV, RUXIENCE, TRAZIMERA, RETACRIT, and NIVESTYM. Coding and coverage policies change periodically and often without warning. The healthcare provider is solely responsible for determining coverage and reimbursement parameters and accurate and appropriate coding for treatment of his/her own patients. The information provided in this section should not be considered a guarantee of coverage or reimbursement for BESPONSA, MYLOTARG, ZIRABEV, RUXIENCE, TRAZIMERA, RETACRIT, and NIVESTYM.
The sample forms are intended as a reference for billing and coding of BESPONSA, MYLOTARG, ZIRABEV, RUXIENCE, TRAZIMERA, RETACRIT, and NIVESTYM. These forms are not intended to be directive or to replace clinical decision-making, and the use of the recommended codes does not guarantee reimbursement. Healthcare providers may deem other codes or policies more appropriate and should select the coding options that most accurately reflect their internal guidelines, payer requirements, practice requirements, practice patients, and the services rendered.
Dedicated Local Support
FOR PRODUCT SUPPORT
If you have questions about a specific Pfizer Oncology product, a Pfizer Oncology Account Specialist can help. He or she is available to provide detailed information—in your office or over the phone.
