YOUR DEDICATED TEAM PROVIDES SUPPORT FOR YOU
AND YOUR PATIENTS
LEQVIO® Service Center
LEQVIO® Service Center
Your single point of contact is a dedicated specialist who can handle all your inquiries and requests for LEQVIO.
LEQVIO-access.com | 1-833-LEQVIO2 M-F 8:00 AM to 8:00 PM (ET)
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Provides support with insurance, coding & billing, and patient savings options
Access & Reimbursement Manager
Available for in-office visits or by phone.
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Offers resources and educational information on acquisition and coding & billing
Self-Service Website
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Comprehensive resources on acquisition, affordability, reimbursement, and all patient support programs
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Alternate Injection Center Locator Tool
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Live Click-to-Chat
LEQVIO-ACCESS.COM
SALES SPECIALIST
SALES SPECIALIST
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Provide clinical product information
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Sales Specialists do not have access to patient-level data
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Review general acquisition information
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Offer information regarding
co-pay and adherence
support options
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Sales Specialists do not have access to patient‑level data
SPECIALIST
BROADLY COVERED AND AFFORDABLE FOR MOST PATIENTS4*
Because it is given by an HCP, LEQVIO® is covered primarily
under the medical benefit,
not the
pharmacy benefit
FOR TRADITIONAL MEDICARE
PATIENTS4
COVERED, AFFORDABLE
NO PRIOR AUTHORIZATION REQUIRED
Have supplemental
plans and
MAY PAY AS LITTLE AS $0
MAY PAY AS LITTLE AS $0
Some supplemental plans may require precertification or prior authorization
PART B medical benefit
Not subject to the Part D pharmacy
benefit donut
hole
Not subject to the Part D pharmacy benefit donut hole
FOR COMMERCIAL AND
MEDICARE
PATIENTS4
COVERED
have confirmed coverage on the
MEDICAL BENEFIT FOR LEQVIO
MEDICAL BENEFIT FOR LEQVIO
patients' medical insurance plans
DO NOT REQUIRE A STEP
THROUGH ANOTHER INJECTABLE
DO NOT REQUIRE A STEP
THROUGH ANOTHER INJECTABLE
HIGHER APPROVAL RATES
when appropriately submitted under the MEDICAL BENEFIT
Most patients PAY 36% LESS† FOR LEQVIO® vs other branded nonstatin treatments4‡
Actual claims data from January to December 2022
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Based on 2100+ medical and pharmacy claims, excluding low-income subsidy patients
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Patient monthly OOPs represent actual yearly cost divided by 12 to reflect an average monthly cost
AFFORDABLE
MAY PAY AS
LITTLE AS $0
PATIENTS PAY
LESS
out-of-pocket annually vs other branded nonstatin treatments, including PCSK9 mAbs†
Approval rates for LEQVIO® are higher when claims are submitted appropriately under the medical benefit4¶
Actual claims data from January to December 2022
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Based on 2100+ medical and pharmacy claims, excluding low-income
subsidy patients
*Coverage information is subject to change by the relevant plan and is based on data up to July 2023. The information provided in this communication is not a guarantee of coverage or payment (partial or full). Actual coverage and reimbursement decisions are made by individual payers following the receipt of claims.4
†The comparison pertains only to differences in cost and should not be considered a comparison of efficacy or safety.4
‡Branded nonstatin treatments include Repatha, Nexlizet, Nexletol, and Praluent.
§Patient out-of-pocket cost calculated from annualized medical and pharmacy claims. Monthly out-of-pocket per brand is based on weighted average of prescribed dose per patient. Data current as of July 2023.
¶Includes Traditional Medicare, Medicare Advantage, and Commercial plans.
$0 Co-pay Savings
Eligible privately insured patients may pay as little as $0 for LEQVIO with the co-pay savings offer. Subject to terms and conditions. Limitations apply.#
Eligible privately insured new patients may be able to receive up to two (2) free doses if coverage is delayed or denied. Limitations apply.**
LEQVIO Care Program
www.careprogram.leqvio.com | 1-833-LEQVIO2
When enrolled, patients on therapy have access to:
- One-on-one support by LEQVIO Care Specialists
- Injection appointment reminders
- Helpful tools, lifestyle
tips, and motivation through text,
mail, and email
The LEQVIO Care Program is a patient support program and is not intended to take the place of medical or clinical advice from a health care provider.
#Eligible patients must have commercial insurance, a valid prescription for LEQVIO, and a prior authorization that has been denied or pending for greater than 3 calendar days. Program provides up to two (2) doses of free medication. Program is not available to patients who are uninsured or whose medications are reimbursed in whole or in part by Medicare, Medicaid, TRICARE, or any other federal or state program, or where prohibited by law. No purchase necessary. Program is not health insurance, nor is participation a guarantee of insurance coverage. Other limitations may apply. Novartis reserves the right to rescind, revoke, or amend the Program and discontinue support at any time without notice.
**Limitations apply. Valid only for those with commercial insurance. The Program may include the Co-pay Card, Payment Card (if applicable), and Rebate, with a per treatment benefit maximum of $1800 and an annual benefit limit of $2400. Per treatment maximums and an annual benefit cap apply. For patients covered under the medical benefit, rebate for out-of-pocket costs will be assigned directly to provider, unless patient requests direct reimbursement. Patient is responsible for any costs once limit is reached in a calendar year. Program not valid (i) under Medicare, Medicaid, TRICARE, VA, DoD, or any other federal or state health care program, (ii) where patient is not using insurance coverage at all, (iii) where the patient's insurance plan reimburses for the entire cost of the drug, or (iv) where product is not covered by patient's insurance. The value of this program is exclusively for the benefit of patients and is intended to be credited towards patient out-of-pocket obligations and maximums, including applicable co-payments, coinsurance, and deductibles. Program is not valid where prohibited by law. Patient may not seek reimbursement for the value received from this program from other parties, including any health insurance program or plan, flexible spending account, or health care savings account. Patient is responsible for complying with any applicable limitations and requirements of their health plan related to the use of the Program. Valid only in the United States and Puerto Rico. This Program is not health insurance. Program may not be combined with any third-party rebate, coupon, or offer. Proof of purchase may be required. Novartis reserves the right to rescind, revoke, or amend the Program and discontinue support at any time without notice.
You can enroll your patients in 3 different ways:
Download and fax our 1-page
start form to 1-877-LEQVIO8
(1-877-537-8468)
Patient Start Form
Enroll your patients electronically
via
ServiceCenterPortal.com
for
all services, including co-pay
CENTER PORTAL
Enroll your patients electronically
via
LEQVIO-CoPayPortal.com
for
co–pay–only support
LEQVIO-COPAY PORTAL.COM
LOOKING FOR MORE
INFORMATION
FOR
YOUR
PATIENTS?
THE CHOICE IS YOURS
Flexible pathways for acquisition and administration
IN-OFFICE
ADMINISTRATION
Acquire LEQVIO through buy-and-bill or a specialty pharmacy
BUY-AND-BILL
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Office purchases LEQVIO from distributor
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Office submits a claim for reimbursement for the cost of LEQVIO and administration
SPECIALTY PHARMACY
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Office submits a LEQVIO prescription to the specialty pharmacy
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Specialty pharmacy sends product to the office
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Once LEQVIO is administered, office submits a claim for cost of administration but not of product
OUT-OF-OFFICE
ADMINISTRATION
Refer patient to an Alternate Site of Care for injection
ALTERNATE SITE OF CARE
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Alternate Site of Care handles ordering LEQVIO, administration, and reimbursement for all services
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Office does not purchase or bill for LEQVIO
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Office purchases LEQVIO from distributor
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Office submits a claim for reimbursement for the cost of LEQVIO and administration
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Office submits a LEQVIO prescription to the specialty pharmacy
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Specialty pharmacy sends product to the office
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Once LEQVIO is administered, office submits a claim for cost of administration but not of product
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Alternate Site of Care handles ordering LEQVIO, administration, and reimbursement for all services
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Office does not purchase or bill for LEQVIO
Have questions?
Contact your Access & Reimbursement Manager
or talk to an Access Specialist at either:
Phone: 833-LEQVIO2 (833-537-8462)
Fax: 877-LEQVIO8 (877-537-8468)
Web: LEQVIO-access.com
Portal: ServiceCenterPortal.com
IN-OFFICE ADMINISTRATION
Acquire LEQVIO through buy-and-bill
or an
SP
BUY-AND-BILL
Administration takes place in
your
office (Medical Benefit)
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Buy-and-bill is an option for acquiring drugs covered under the medical benefit that are administered by a health care provider
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Drugs covered under Medicare Part B (fee-for-service) must be acquired through this method
THE BUY-AND-BILL
PROCESS
Verify benefits
Order LEQVIO through a distributor
HCP/office staff orders LEQVIO, assuming responsibility for storing and handling. A list of authorized LEQVIO distributors can be found here. If your practice is part of a system that uses a central purchasing model, then the buy-and-bill process steps may not apply
Administer LEQVIO
HCP administers LEQVIO in their office
Submit claim
HCP/office staff submits claim to payer for reimbursements
Manage reimbursement
HCP/office staff receives reimbursement from payer and collects balance due (if any) from patient
ABOUT BUY-AND-BILL
SPECIALTY PHARMACY
Administration takes place within your office via an SP
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A patient's plan may restrict drug coverage under the pharmacy benefit using an SP
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LEQVIO ordered through an SP must be given to the specific patient for whom it was ordered (unlike the buy-and-bill, in which LEQVIO can be given to any patient for whom it's prescribed)
THE SP
PROCESS
Patient's plan restricts coverage to the pharmacy benefit, or HCP prefers this pathway and the patient is eligible for the pharmacy benefit
Send Rx
HCP sends prescription via e-prescribing platform to SP
Benefits verification (BV)
SP conducts BV, receives Statement of Benefits, and coordinates prior authorization or precertification as needed
Patient payment
Patient pays co-pay/coinsurance or deductible when SP dispenses LEQVIO
Send drug
SP sends LEQVIO to HCP practice or as dictated by insurance coverage
Store and schedule
HCP practice schedules patient injection visit and stores LEQVIO if needed
Administer
HCP practice administers LEQVIO to the patient
Collect for services
HCP practice collects patient co-pay for any services (administration fee)
SERVICE CENTER
OUT-OF-OFFICE
ADMINISTRATION
Send order to an AIC, which manages
LEQVIO
acquisition via buy-and-bill
ALTERNATE INJECTION CENTER (AIC)
Administration takes place at a site other than your office*
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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
THE HCP/OFFICE STAFF
ROLE IN THE ALTERNATE
SITE OF CARE PROCESS
Locate
HCP/office staff finds an Alternate Site of Care that is convenient for the patient
Refer
HCP/office staff contacts Alternate Site of Care to determine referral requirements, then completes and submits the referral form, including the LEQVIO order with all the required information to the Alternate Site of Care
Follow-up
HCP may receive a report on the patient's LEQVIO administration from the Alternate Site of Care and determines whether follow-up between appointments may be necessary for the patient
*May include a clinic, hospital outpatient department, or another physician's office.