Choose the option that works best for you and your patient

Alternate Site of Care

Administration takes place at a site other than your office*

Practice locates and refers the patient to an alternate site of care, which then handles the following:

• Benefits verification
• Prior authorization support
• Acquisition of LEQVIO
• Administration of LEQVIO
• Submitting claims for reimbursement

A system hospital outpatient department (HOPD) may act as an alternate site of care. It's important to understand system requirements before sending the LEQVIO patient to that facility.  

*May include a clinic, hospital outpatient department, or another physician’s office. 

Refer to the LEQVIO Clinical Documentation Referral Checklist for examples of what information is usually required.

Alternate site of care referral considerations for LEQVIO

Get additional details on how you can refer patients to an alternate site of care to handle ordering, administration, and reimbursement for all services.

Buy-and-bill

• Buy-and-bill is an option for acquiring medications covered under the medical benefit that are administered by a health care provider
• Drugs covered under Medicare Part B (fee-for-service) must be acquired through this method

The buy-and-bill process takes place in 5 simple steps:

1. Verify benefits
   • HCP/office staff member confirms the patient’s benefits with their medical insurance plan
   • If you need assistance, reach out to the LEQVIO Service Center ↗
2. Order LEQVIO through a distributor
   • HCP/office staff member orders LEQVIO, assuming responsibility for storing and handling. A list of authorized LEQVIO distributors and group purchasing organizations (GPOs) can be found below. If your practice is part of a system that uses a central purchasing model, then the buy-and-bill process steps may not apply
3. Schedule the patient's appointment and administer LEQVIO
   • HCP administers LEQVIO in their office
   • Remember to help your commercially insured patients enroll in the LEQVIO^® Co-pay Program
4. Submit claim
   • HCP/office staff member submits claim to payer for reimbursements
5. Manage reimbursement
   • HCP/office staff member receives reimbursement from payer and collects balance due (if any) from the patient  
   • Submit and manage co-pay claim for reimbursement for your commercially insured patients who are enrolled in the LEQVIO Co-pay Program

LEQVIO via buy-and-bill with in-office administration

Find out more about acquiring HCP-administered products like LEQVIO through buy-and-bill, the primary method of acquisition.

LEQVIO distributors

If you intend to buy-and-bill, LEQVIO can be ordered through our authorized distributors.

Novartis does not recommend the use of any particular distributor.

Group purchasing organizations

If you intend to work with a group purchasing organization (GPO), you can order through the following companies.

Novartis does not recommend the use of any particular group purchasing organization. 

Specialty pharmacy (SP)

• A patient’s plan may restrict drug coverage under the pharmacy benefit using an SP
• LEQVIO ordered through an SP must be given to the specific patient for whom it was ordered (unlike through buy-and-bill, in which LEQVIO can be given to any patient for whom it’s prescribed)

The SP process
The patient’s plan restricts coverage to the pharmacy benefit, or HCP prefers this pathway and the patient is eligible for the pharmacy benefit.

1. Send Rx: HCP sends prescription via e-prescribing platform to SP.

2. Benefits verification (BV): SP conducts BV, receives Statement of Benefits, and coordinates prior authorization of precertification as needed.

3. Patient payment: Patient pays co-pay/coinsurance or deductible when SP dispenses LEQVIO.

4. Send drug: SP sends LEQVIO to HCP practice or as dictated by insurance coverage.

5. Store and schedule: HCP practice schedules patient injection visit and stores LEQVIO if needed.

6. Administer: HCP administers LEQVIO to the patient.

7. Collect for services: HCP practice collects patient co-pay for any services (administration fee).

For HCPs or facilities with technical complaints and replacement requests related to product administration or user error issues, temperature stability issues, and damaged, dropped, or lost units, contact the Customer Interaction Center at 1-888-NOW-NOVA (1-888-669-6682).

For HCPs or facilities choosing to return expired LEQVIO units, contact the Customer Interaction Center at 1-888-NOW-NOVA (1-888-669-6682).

For wholesalers or distributors choosing to replace damaged or expired LEQVIO units, contact Novartis Pharmaceuticals Corporation at 1-800-526-0175 or email [email protected].