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Insurance Tools and Resources
The information presented below
includes helpful tools and resources to assist you in obtaining the most from
your health insurance coverage for Kineret®.
Steps to Filling Your Prescription: A Patient Checklist
Step 1: Understand Your Insurance Benefits
Before filling your prescription for Kineret®, it will be important for you
to understand your insurance benefits. This information can be accessed in two ways:
(1) by calling your insurance company directly or
(2) by calling 1-866-KINERET (1-866-546-3738) and requesting that a reimbursement counselor contact
your insurance company on your behalf.
Please note that if you contact the Kineret® Customer Call Center, you will
be required to complete the attached Patient Authorization Form.
 Download
Patient Authorization Form (PDF, 20 Kb)
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Regardless of how you access the
information, be prepared to provide:
- Your name, date of birth, and social security number
- Your insurance company name and phone number (if calling
the Kineret® Customer Call Center at 1-866-KINERET
or 1-866-546-3738)
- Your policy number
- The cardholder's name, date of birth, and social security number (if it is not you)
Also be sure to ask the right questions. Find out:
- Is Kineret® covered under my plan? If Kineret®
is not covered, what is the appeal process?
- Does Kineret® require
prior authorization? If prior authorization is required:
- What is the process? Is there a form that must be completed?
- Who is required to complete the process? Does my physician have a role?
- What is the turnaround for a decision?
- If my prior authorization request is denied, may I appeal this decision?
- How much will I have to pay for Kineret®?
- Do I have to meet a deductible?
- Do I have a co-payment or co-insurance?
- Are there any limitations to this coverage?
- Do I have a benefit cap?
- Do I have any out-of-pocket maximums?
- Do I have to access Kineret® from a particular pharmacy?
- If not, what options are available to me?
Step 2: Call Your Pharmacy
If you have decided to have your prescription filled at a local pharmacy, call ahead to
inquire about their stock of Kineret®. If your pharmacist does not
have Kineret® in stock, request that it be ordered and confirm
the delivery date.
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Resources
Doctor's Office
If you have questions about Kineret® therapy, talk to the
health care professional in your doctor's office. The health care professional
should be knowledgeable about therapy with Kineret® and should
be able to address your questions or direct you to the appropriate resource.
Additionally, the health care professional will have access to your medical
records and can advise you of your medical situation and need for
Kineret® therapy. The health care professional may call
the Kineret® Customer Call Center at
1-866-KINERET (1-866-546-3738)
to be connected with a Customer Call Center
representative if there are any additional questions about Kineret®.
Kineret® Customer Call Center
Reimbursement counselors will be available Monday through Friday, 8 AM
to 8 PM EST, to assist you with your insurance questions. To be
connected to a reimbursement counselor, call
the Kineret® Customer Call Center at
1-866-KINERET (1-866-546-3738).
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Frequently Asked Questions
| Q. |
Will my health insurance pay for Kineret®? |
| A. |
Coverage for Kineret® will vary widely by the type of health
insurance that you have, as well as by your individual health plan.
If you have any questions regarding your insurance coverage for Kineret®,
please call the Kineret® Customer Call Center at
1-866-KINERET (1-866-546-3738). |
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| Q. |
Who can help if I don't have insurance coverage for Kineret®? |
| A. |
If you do not have insurance coverage for Kineret® or if your prescription benefits are
limited, please contact the Kineret® Customer
Call Center at 1-866-KINERET (1-866-546-3738) for assistance. Trained reimbursement
counselors, as part of Kineret® Reimbursement Services, will be available to assess your
individual situation. Based on your needs, reimbursement counselors will customize the
assistance provided to you, including
- Assisting you and your physician with the appeals process if coverage for Kineret® has been denied
- Researching the availability of state or local programs that may be able to assist you
with coverage for Kineret®
Based on your insurance and financial situation, you may be eligible to receive assistance
through the SAFETY NET® Foundation for Kineret®. For more information about the
SAFETY NET® Foundation, please contact
the Kineret® Customer Call Center at
1-866-KINERET (1-866-546-3738).
Download SAFETY NET® Instructions and Application (PDF, 32 Kb)
| You need to have Adobe® Acrobat®
installed to view PDF files. If you do not have Acrobat®
Reader®, you can
download
it for free from the Adobe® website. |
|
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| |
| Adobe® Reader®
is a registered trademark of Adobe Systems, Inc. |
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| Q. |
What is prior authorization? |
| A. |
Prior authorization means approval from your insurance company for you to receive Kineret®.
If your insurance company requires this approval, you must obtain prior authorization before
you fill your prescription for Kineret®. Prior authorization is part of a "checks and balances"
system to make sure that Kineret® is medically necessary and appropriate for your condition.
If you need help understanding your insurance company's prior authorization process,
the Kineret® Customer Call Center is ready to assist you
at 1-866-KINERET (1-866-546-3738). |
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| Q. |
What questions should I ask my insurance company to find out if they require prior authorization? |
| A. |
The following questions will be helpful when you make this important phone call:
- Does my health plan require prior authorization for Kineret®?
- What is the process for obtaining prior authorization?
- Is there a special phone number or fax number to call for prior authorization?
- Exactly what information must accompany the request? [Sometimes your doctor must send a letter of medical necessity.]
- To what address or fax number does my doctor send this information?
- How long will it take for a decision?
- How will I find out if Kineret® has been prior authorized?
- If Kineret® is authorized, for how long is the authorization valid (or when will it "expire")?
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| Q. |
Where do I get Kineret®? |
| A. |
If your insurance company covers Kineret®, they will probably have
guidelines for you to follow regarding where you may get Kineret®. Many
insurance plans require that you have your prescriptions filled at an
in-network pharmacy. In some cases, going to an out-of-network pharmacy
may mean that your prescription may not be covered at all.
If you are unsure whether or not your health plan has a pharmacy network,
ask someone in your employer's benefits department or call your insurance
company directly. If there is a network, you will need to obtain a list
of network pharmacies by calling the customer service phone number on
your insurance or prescription drug card.
When talking to your insurance company, it will also be important to ask what
your options are for getting Kineret®. Your health plan may provide you the
option of accessing Kineret® through your local pharmacy or by mail—or they
may require that you use one versus another. If you do have options, review
them carefully, as one option may be more desirable than the other depending on your individual circumstances.
Please contact the Kineret® Customer Call Center at
1-866-KINERET (1-866-546-3738) for assistance. |
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| Q. |
Who files the claim with my insurance company for Kineret®? |
| A. |
Most often, your pharmacy will send the claim to your insurance company on your behalf,
as long as you provide the pharmacy with your insurance information. Some pharmacies will
request that you pay for Kineret® up front and file the insurance claim yourself so that
your insurance company can pay you back.
In this case, call your insurance company and ask about the claim submission
process so that you can be paid back as quickly as possible for Kineret®. Most
health plans have a specific claim form that you must complete for prescription
drugs. You can typically obtain this form from your insurance company or from your
employer.
Call the Kineret® Customer Call Center at
1-866-KINERET (1-866-546-3738) if
you have any questions about filing your own claim for
Kineret®. Our reimbursement counselors will be pleased to assist you with
the process. |
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| Q. |
What if my insurance company denies my request for Kineret®? |
| A. |
The good news is that a number of claims denials or prior authorization denials
can be successfully overturned with some effort on your part and that of your
doctor. In fact, many denials are caused by simple mistakes or incomplete
information that can be addressed easily by making a phone call to the
insurance company. Other denials, however, may warrant a resubmission of
your claim or submission of more documentation to support the prior
authorization process. You can appeal an unfavorable decision by formally
asking your insurance company to reconsider your prior authorization
request or your claim for payment of Kineret®.
Although many unfavorable decisions are successfully overturned, the process for appealing
denied claims or appealing unfavorable prior authorization decisions can be intimidating.
We encourage you to call the Kineret® Customer Call Center at 1-866-KINERET (1-866-546-3738), where
a reimbursement counselor can walk you through the appeal process. |
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| Q. |
What is a formulary and what does it mean for Kineret®? |
| A. |
It is typical of private insurance and Medicaid to maintain a list of covered drugs,
known as a formulary.
You will need to call your insurance company to find out if Kineret® is on the formulary.
Special committees determine which drugs are added to the formulary.
You will need to call your insurance company to find out if Kineret® is on the formulary.
Some insurance companies include self-injected medications like Kineret® under
the medical benefit instead of the prescription drug benefit, so a formulary is
less relevant in those cases.
If Kineret® is not on your health plan's formulary, you still have several options:
- Your doctor can make a special request for Kineret® through the prior authorization process.
- Sometimes, health plans may allow you to access nonformulary medications for
a slightly higher co-pay or co-insurance amount.
- You can call the Kineret® Customer Call Center at
1-866-KINERET (1-866-546-3738) for information on the appeals process.
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