When my MD first told me about Brinsupri, if I'm remembering correctly, he said that I would need to be pre-approved for the drug. If interested, his nurse would complete the paperwork - I just had to sign off on it - so I agreed. Once approved, and I got the impression it had to do with the severity of your disease/symptoms, then you go through the process of insurance approval. From start to finish it took about a month from initial application to actually receiving the first prescription. The first call I got was from Lauren in the inLighten Support department letting me know my application was approved. I was told that Amber Specialty Pharmacy would be calling me to verify the insurance info they had been given and we'd talk about my co-pay. She also said I would get a call from one of their educators after I received the first packet of information to review it with me and answer any questions I had. Carrissa called the day I received the packet. She let me know that she would be following up every 6 months, I think but I could call at any time with questions. Lauren was the first one to mention the grant program in case I needed financial support to help with the cost.
A rep from Amber called soon after I spoke with Lauren to verify my insurance. He said he'd get back with me that day to let me know about the dollars and cents. And he did. He told me my monthly copay would be $1695.00. Yikes. I said no way................He did say, depending on your Medicare plan, if Medicare denied to pay then you're responsible for the full amount. I was thinking Medicare denied it with that sticker price, but he said that it wasn't denied, but that was still my part of the payment. When I told him I'd have to decline, he gave me the number to call The Assistance Fund to apply for a grant. Said it would only take a couple of hours to find out if I qualified. So, I did. And I qualified. It took less than 30 minutes. They pick up the total amount of your portion after insurance pays, so I will pay nothing until 12/26, at which time you have to reapply. I let inLighten know that I'd spoken to Amber and she was surprised that he gave me the TAF number. Either way, that was my process. It starts with the doctor and ends with the specialty pharmacy. I made a few calls but that was it. Hope this helps!
I tend to overexplain, so forgive the rambling.
Karen