Comprehensive Reimbursement Support
This reimbursement support program was designed with PRIALT prescribers to help appropriate patients get access to PRIALT.
|PRIALT Access & Support Program Overview. Click here to download.|
How can the program help my practice with treatment access for appropriate PRIALT patients?
- Healthcare providers:
Before you place a PRIALT order, this program can help determine insurance coverage and explore financial options for appropriate PRIALT patients.
- Your dedicated Case Manager can provide comprehensive and on-going support.
This program can identify ways to reduce out of pocket costs.
LET’S GET STARTED
|After determining a patient is appropriate for PRIALT therapy, office submits the PRIALT Enrollment and Patient Authorization Form.
Download form, complete mandatory fields, ask patient to sign authorization and fax to 1-855-PRIALT3 (1-855-774-2583).
Your patient can also complete the authorization online through our online Patient Authorization Form at https://prialt.ehipaa.com/access/#/patient/info-form.
Your Case Manager will contact you.
|Eligible patients with commercial insurance may qualify for the PRIALT Savings Program.