Access and support for your patients on NUCALA

 

After prescribing NUCALA, the following information will guide you through the steps in helping appropriate patients access NUCALA. Additional resources and links can also be found below.

1. Verify patient benefits

Gateway to NUCALA can help you navigate the insurance process for covering NUCALA. You may also contact the specialty pharmacy or patient’s payer directly.

 

 

 

Initiate a benefits investigation

Verify benefits by working with Gateway to NUCALA or contacting the payer directly. Benefits investigations do not guarantee coverage. If your patient is not enrolled in Gateway to NUCALA, please complete the enrollment form above.

If the patient will receive treatment at an alternative site of care (ASOC):

 

Consult the patient’s insurance or contact Gateway to NUCALA to identify an appropriate ASOC. Work with the ASOC to determine responsibility for benefits investigation and prior authorization.

 

Prior authorization (PA)

  • Determine any PA requirements. Gateway to NUCALA can provide PA support for enrolled patients. Gateway to NUCALA cannot complete PA forms or submit related information to plans.
  • Obtain needed forms from the patient’s plan
  • Follow up with the patient’s plan to determine PA submission status if requested

CoverMyMeds developed and maintains the website and is responsible for its content. Neither GSK nor CoverMyMeds can guarantee success in obtaining third-party coverage or reimbursement. It is always the healthcare provider's responsibility to provide and submit accurate and complete information. Providers should contact prescription health plans for specific information on their coding, coverage, and payment policies.

 

All trademarks, trade names, or logos mentioned or used are the property of their respective owners. CoverMyMeds and GSK are not affiliated entities.

 

Important Notice: Information regarding CoverMyMeds is brought to you as a courtesy of GSK.

 

Appeals support

  • If PA is denied, and you feel that NUCALA is appropriate for your patient, you can consider an appeal

  • Gateway to NUCALA can help you and your patient understand the appeals process
  • See below for sample letters of appeal and medical necessity 

2. Patient access support

The following assistance programs may be available for your patients:

  • Gateway to NUCALA will evaluate the patient’s eligibility for GSK’s sponsored assistance programs. Call 844-4-NUCALA (844-468-2252) Monday through Friday, 8 AM to 8 PM ET
  • The NUCALA Co-pay Program can help eligible patients covered by commercial insurance pay as little as $0 for NUCALA (maximum of $15,000 for 12 months). See full terms and conditions
  • Bridge to NUCALA Program offers free product to eligible commercially insured patients when their initial prior authorization process exceeds 14 days
  • The NUCALA Patient Assistance Program may help your uninsured patients who meet eligibility criteria to obtain access to NUCALA free of charge

3. Arrange for patient to receive NUCALA

NUCALA is available through a variety of distribution options based on the site of care. Gateway to NUCALA can help identify the options that may be available for your patient.

At-home administration

  • Send the prescription to an in-network specialty pharmacy
  • Inform patient to expect a call from the specialty pharmacy to approve shipment and provide co-pay

View at-home administration

In-office administration

Specialty pharmacy

  • Order NUCALA from an in-network specialty pharmacy
  • Inform patient to expect a call from the specialty pharmacy to approve shipment and provide co-pay
  • Verify the correct shipping address and shipping date with the specialty pharmacy, and follow up as needed

Buy and bill

  • Order NUCALA from specialty distributor once prior authorization is approved

Alternative site of care

  • Confirm appointment for administration has been scheduled at alternative site of care

Find specialty pharmacies and distributors currently participating in the distribution network for NUCALA.

View in-office administration

4. Billing and reimbursement

Gateway to NUCALA can help provide information about relevant codes and identify coding requirements for NUCALA.

Permanent J-code for NUCALA

Permanent J-code for NUCALA

J2182

 

Your practice or hospital outpatient department may need more information on Centers for Medicare and Medicaid Services (CMS) claims forms 1500 and 1450. Details and examples of each are provided below.

5. Help patients start successfully

After ordering NUCALA for patients, there are steps you can take to help patients start:

  • Instruct patients to accept and return calls from the specialty pharmacy to prevent delays in starting treatment. Specialty pharmacies may not mention NUCALA in messages, as brand names may be omitted to protect privacy
  • Encourage patients to take advantage of the MyNUCALA patient support program
MyNUCALA logo

Patient Support Program

MyNUCALA offers tools and services to help patients along their NUCALA journey including:
  • Autoinjector patient starter kit
  • Progress trackers
  • Doctor conversation starters
  • Nurse Support Line to help answer patient questions about NUCALA

Learn more about MyNUCALA