A copy of the complete Reimbursement Guide for PRIALT is available for download.

Medicare
PRIALT is generally covered by Medicare under the Centers for Medicare and Medicaid Services' (CMS) Infusion Pumps National Coverage Determination (NCD) if a provider's medical staff determines: 

  - PRIALT is reasonable and necessary for the treatment of the individual patient;

  - PRIALT be administered by an implanted infusion pump; and

  - Infusion pump is FDA approved for the administration and indicated for use with PRIALT^1* 

Medicaid
State Medicaid programs provide medical assistance to eligible low income and disabled beneficiaries. In general, Medicaid programs will cover drugs for their FDA approved indications. 

Private Payers 
Coverage for PRIALT may vary by private payer. Providers should contact the local payers or the Elan Pain Information Center (EPIC) for specific coverage information. Unlike Medicare, private payers may require prior authorization for PRIALT before treatment. 

Providers should contact the Elan Pain Information Center at 1-888-PRIALT-1   (1-888-774-2581) or consult with individual payers for local coverage information and reimbursement policies.

Footnote/reference: 

1 http://www.fda.gov/cdrh/pma/pmafeb05.html 

* With the exception of morphine sulfate and balcofen, PRIALT is the only intrathecal drug approved by the FDA for use in an implantable infusion pump.