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Content for access and reimbursement - inpatient - before accordion

Content for access and reimbursement - inpatient - after accordion

Content for access and reimbursement - outpatient - before accordion

BENEFITS
VERIFICATION

We Help determine available coverage Pfizer Oncology Together can conduct a benefits verification to determine your patient's health insurance coverage, including co-pay responsibility and other out-of-pocket costs for BESPONSA.

Enrollment form
Fax a completed enrollment form to 1-877-736-6506

PRIOR
AUTHORIZATION

We assist with understanding insurance authorization Pfizer Oncology Together will coordinate with the insurer to determine all prior authorization requirements, where and how to submit requests and typical turnaround times. We will also follow up with the payer on behalf of the patient—and track the process until a final outcome is determined.

APPEALS
ASSISTANCE

WE OFFER APPEALS ASSISTANCE If your patient's claim is denied, Pfizer Oncology Together can work with you to review the reason for the denial and help you better understand the appeals process. Once the appeal is submitted, we will follow up with the payer on behalf of the patient—and track the process until a final outcome is determined.

Pfizer and its representatives cannot make any guarantees about the outcome of appeals assistance.

(Monday–Friday 8 am–8 pm ET)

BILLING AND CODING ASSISTANCE

National Drug Code (NDC)

Product Name

BESPONSA

(inotuzumab ozogamicin)

NDC (11-digit format)

NDC 00008-0100-01

Description

0.9 mg single-dose vial

Route of Administration

Intravenous infusion

Content for access and reimbursement - outpatient - after accordion

For codes you may need when coding for BESPONSA in an outpatient or physician’s office setting, download the forms below.

The information provided here is intended for informational purposes only, and is not a comprehensive description of potential coding requirements for BESPONSA. 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.

SAMPLE UB-04/CMS-1450 FORM FOR HOSPITAL OUTPATIENT USE

SAMPLE CMS-1500 FORM FOR PHYSICIAN OFFICE USE

ORDERING BESPONSA (inotuzumab ozogamicin)

Pfizer has made BESPONSA available through a network of specialty distributors and one specialty pharmacy.

Specialty Distribution Partners
Customer Service Number
Website
Item Number
ASD Healthcare
Item Number : 49307
Biologics Specialty Pharmacy
Item Number : --
Cardinal Health Specialty Solutions
Item Number : 5390364
McKesson Plasma and Biologics
Item Number : 3700093
McKesson Specialty Health Solutions
Item Number : 5007354
Oncology Supply
Item Number : 49307
Smith Medical Partners
Item Number : 5680723

FIELD REIMBURSEMENT SUPPORT

In the event you need additional assistance or support in your office, we can put you in touch with a local Pfizer Field Reimbursement Manager (FRM) who is trained to address specific access and reimbursement issues.

(Monday–Friday 8 am–8 pm ET)

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