Support for You and Your Patients
CINQAIR Cost Support Program
Teva Support Solutions® provides savings and support for you and your patients.
1-844-838-2211
Monday – Friday
9 am – 5:30 pm ET
$ 0
Medication costs per dose
Administration costs
per treatment
Up to $10,000 per year*
The CINQAIR® Cost Support Program helps eligible, commercially insured individuals pay out-of-pocket medication and administration costs, including co-insurance, co-pays, and deductibles.
Use the CINQAIR® Cost Support Program Form to get started and enroll your patient. Once enrolled, we will call your patient to confirm enrollment and send a CINQAIR Cost Support Program Card to use with their treatment provider to pay the out-of-pocket costs for treatment with CINQAIR, if eligible.
*The CINQAIR Cost Support Program helps commercially insured individuals in the United States (including the United States territories) who are prescribed CINQAIR pay for their eligible out-of-pocket costs for the drug and for administration of the drug, including co-pays, co-insurance, and deductibles.
Persons residing in a state that does NOT allow financial assistance for the administration of the drug may ONLY be eligible to receive out-of-pocket cost support for the drug.
The Program does not cover the costs of physician office visits or evaluations, blood work or other testing, or transportation. Eligible individuals must have commercial insurance for CINQAIR. Uninsured and cash-paying patients are NOT eligible for this Program, nor are individuals with commercial insurance coverage that does not provide coverage for CINQAIR.
How Patients Use the Cost Support Program Card
Eligible patients use the Cost Support Program Card to help pay out-of-pocket costs for treatment with CINQAIR® at their infusion treatment provider.
Here’s how the CINQAIR® Cost Support Program works:
1
Submit claim
A claim is submitted to the patient’s insurance plan after each infusion.
2
Receive EOB
The treatment provider and patient will receive an Explanation of Benefits (EOB) statement from the patient’s insurance plan (this may take several weeks).
3
Submit EOB
The EOB will then be submitted by the patient or provider, but not both, to the CINQAIR® Cost Support Program. No other forms are needed.
4
Issue funds
The CINQAIR® Cost Support Program will review the EOB, and issue funds to the patient’s Program Card, if eligible. The patient will be notified when this occurs.
5
Pay out-of-pocket costs
Once funds are on the patient’s Program Card, they can use it to pay their out-of-pocket costs at their treatment provider.
Patients use the CINQAIR® Cost Support Program Card to pay out-of-pocket costs for treatment with CINQAIR®.
Codes for CINQAIR
The following codes are commonly used to communicate services rendered when filing claims for CINQAIR. Codes for CINQAIR may vary by payer or site of care.*
|
ICD-10 CODES |
You should select the appropriate diagnosis code based on your clinical diagnosis. If you have questions about coverage for certain diagnosis codes, please contact the patient’s insurance plan. |
|
NDC CODES |
NATIONAL DRUG CODE 59310-610-31 (FDA 5-3-2 Format) When filing a claim, you may need to add a zero (0) on the claim form as follows: 59310-0>610-31. NOTE: Do not include hyphens (-) on the claim form. |
|
HCPCS CODES |
MEDICATION LEVEL II J2786 Injection, reslizumab, 1 mg |
|
CPT® CODES |
INFUSION ADMINISTRATION 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug HOME INFUSION 99601 Home infusion/specialty drug administration, per visit (up to 2 hours) |
* Providers are responsible for the accuracy of any claims, invoices, or related documentation submitted to payers. Contact your payer for specific guidance.
Acquiring CINQAIR
CINQAIR® can be ordered from one of our Authorized Specialty Distributors (Buy & Bill) or, subject to a patient’s health plan requirements, CINQAIR® may also be acquired from a specialty pharmacy.
Buy & Bill
These Authorized Speciality Distributors are the exclusive suppliers of CINQAIR®.
CuraScript SD
Phone: 1-877-599-7748
Fax: 1-866-628-8942
Metro Medical A Cardinal Health company
Phone: 1-800-768-2002
Fax: 1-615-256-4194
Contact the individual specialty distributor for current pricing.
Speciality Pharmacy
Providers preferring to acquire CINQAIR® via specialty pharmacy, or if the patient’s health plan requires, CINQAIR® can be acquired though a specialty pharmacy. Check with the patient’s health plan to confirm specialty pharmacy requirements.
Teva Cares Foundation
For patients who are uninsured or unable to afford CINQAIR, the Teva Cares Foundation may be able to help.
Teva Cares is an independent, non-profit program that provides CINQAIR at no cost to eligible patients*. To learn more visit TevaCares.org or call 1-877-237-4881.
*Patient must reside in the United States, meet insurance and income requirements, and have a valid prescription.