COVERAGE & REIMBURSEMENT SUPPORT FOR RENFLEXIS

The Merck Access Program can help you understand the benefit investigation, prior authorization, and appeal processes.
For more information, please select a category below.
Benefit
Investigations
Prior
Authorizations
Appeals
The Merck Access Program can contact insurers to request patient-specific coverage and benefits information for RENFLEXIS, including:
  • whether the plan covers RENFLEXIS;
  • deductible, coinsurance, and out-of-pocket maximum amounts; and
  • whether the plan has prior authorization or step therapy requirements.
Getting started is simple
For patient-specific coverage questions:
  • Download and complete the appropriate sections of the enrollment form. If your patient is eligible and interested in co-pay assistance or the Merck Patient Assistance Program, please have the patient complete the appropriate sections on the form.
  • Fax signed, completed forms (whether downloaded, or completed electronically and then printed) to 800-376-2580.
  • A program representative will contact your patient and your office.
To view a form, click on its name. To have form(s) e-mailed, click the checkbox(es) then tap “E-mail Selected Forms”.
 
2018 2019
 
E-mail Selected Forms
If a prior authorization is required, for assistance in understanding if a prior authorization is required, or if a prior authorization request has been denied, the Merck Access Program may be able to help.
To view a form, click on its name. To have form(s) e-mailed, click the checkbox(es) then tap “E-mail Selected Forms”.
 
Getting started is simple
For patient-specific authorization questions:
  • Download and complete the appropriate sections of the enrollment form. If your patient is eligible and interested in co-pay assistance or the Merck Patient Assistance Program, please have the patient complete the appropriate sections on the form.
  • Fax signed, completed forms (whether downloaded, or completed electronically and then printed) to 800-376-2580.
  • A program representative will contact your patient and your office.
 
2018 2019
E-mail Selected Forms Use Online Portal
If you have submitted a claim and the claim has been denied, you can submit an appeal to your patient’s insurer.
The Merck Access Program may be able to help your office understand the information needed for an appeal submission.
The appeal checklist and sample letter below can help you to understand the documents and information that may be helpful when filing an appeal. As always, you should check for payer-specific requirements.
To view a form, click on its name. To have form(s) e-mailed, click the checkbox(es) then tap “E-mail Selected Forms”.
 
Getting started is simple
For patient-specific authorization questions:
  • Download and complete the appropriate sections of the enrollment form. If your patient is eligible and interested in co-pay assistance or the Merck Patient Assistance Program, please have the patient complete the appropriate sections on the form.
  • Fax signed, completed forms (whether downloaded, or completed electronically and then printed) to 800-376-2580.
  • A program representative will contact your patient and your office.
 
2018 2019
E-mail Selected Forms Use Online Portal
The information available here is compiled from sources believed to be accurate, but Merck makes no representation that it is accurate. This information is subject to change. Payer coding requirements may vary or change over time, so it is important to regularly check with each payer as to payer-specific requirements.
The information available here is not intended to be definitive or exhaustive, and is not intended to replace the guidance of a qualified professional advisor. Merck and its agents make no warranties or guarantees, express or implied, concerning the accuracy or appropriateness of this information for your particular use given the frequent changes in public and private payer billing. The use of this information does not guarantee payment or that any payment received will cover your costs.
You are solely responsible for determining the appropriate codes and for any action you take in billing. Information about HCPCS codes is based on guidance issued by the Centers for Medicare & Medicaid Services applicable to Medicare Part B and may not apply to other public or private payers. Consult the relevant manual and/or other guidelines for a description of each code to determine the appropriateness of a particular code and for information on additional codes. Diagnosis codes should be selected only by a health care professional.
  HCPCS = Healthcare Common Procedure Coding Systems.
Before prescribing RENFLEXIS, please read the accompanying Prescribing Information, including the Boxed Warning about serious infections and malignancies. The Medication Guide also is available.

 
Before prescribing RENFLEXIS, please read the accompanying Prescribing Information, including the Boxed Warning about serious infections and malignancies. The Medication Guide also is available.

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