PharmaEssentia SOURCE can help assess your patient’s health insurance coverage and estimated out-of-pocket costs.
We will coordinate with your patient’s insurance company to determine if there are any prior authorization (PA) requirements.
If a PA is required, we’ll help determine what the submission process is, including if additional documentation is required.
After your office submits the PA request, we’re available to help you monitor the PA request status.
We can work with you to identify the steps necessary to appeal the payer’s decision.
You may need one or more types of documents to initiate an appeal. The sample documents below may help you through this process.
This document verifies that the medication you are prescribing is for the diagnosis and treatment of your patient’s disease.
This document requests a reconsideration after a PA denial.
This document requests that a formulary restriction placed on BESREMi be removed, as it is medically appropriate and necessary for your patient’s treatment.
© 2022 PharmaEssentia Corporation. All rights reserved.
BESREMi, the
BESREMi logo, and PharmaEssentia are registered trademarks of PharmaEssentia Corporation, and
the PharmaEssentia logo, PharmaEssentia SOURCE, and the PharmaEssentia SOURCE logo are
trademarks of PharmaEssentia Corporation. US-BSRM-2100061 (v6.0) 12/2022
800-700-5053
