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Access & Reimbursement

We’re Here to Help Navigate the Access and Reimbursement Process

Benefits Investigation

PharmaEssentia SOURCE can help assess your patient’s health insurance coverage and estimated out-of-pocket costs.

Prior Authorization

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.

Appeals Support

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.

Sample Letter of Medical Necessity

This document verifies that the medication you are prescribing is for the diagnosis and treatment of your patient’s disease.

Sample Letter of Appeal

This document requests a reconsideration after a PA denial.

Sample Formulary Exception Letter

This document requests that a formulary restriction placed on BESREMi be removed, as it is medically appropriate and necessary for your patient’s treatment.

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