Financial Assistance for Patients with Commercial Insurance
AAA PatientCONNECT™ may provide treatment co-pay assistance for LUTATHERA® (lutetium Lu 177 dotatate) treatment to patients who have commercial insurance and meet certain eligibility criteria.1
AAA PatientCONNECT™ — LUTATHERA® CO-PAY ASSISTANCE PROGRAM
TERMS AND CONDITIONS
- Limitations apply.
- The Advanced Accelerator Applications (AAA) PatientCONNECT™ LUTATHERA Co-pay Assistance Program (the “Program”) is valid only for patients with commercial insurance coverage who are otherwise eligible for the program. The program is not valid under Medicare, Medicaid, or any other federal or state program; for cash-paying patients; where the product is not covered by the patient’s commercial insurance; or where the patient’s insurer reimburses the patient for the entire cost of LUTATHERA® (lutetium Lu 177 dotatate) injection.
- The patient is obligated to notify AAA PatientCONNECT™ at 1-844-638-7222 promptly if the patient’s insurance coverage changes or the patient otherwise becomes ineligible for coverage under the program.
- Patient must be age 18 or older.
- Patient must be a permanent resident of the United States, the Commonwealth of Puerto Rico, or the US Virgin Islands.
- Patient must be prescribed LUTATHERA for an US Food and Drug Administration-approved indication.
- Treatment with LUTATHERA must be provided in an appropriate outpatient setting.
- The Program provides that an eligible patient will be responsible for the first $25.00 and then may receive assistance for up to a maximum of $15,000.00 over the course of the treatment (ie, 4 LUTATHERA infusions) to cover eligible out-of-pocket costs for LUTATHERA. After the maximum coverage is reached, the patient will be responsible for any out-of-pocket costs incurred.
- Patient must have an out-of-pocket cost for LUTATHERA and be administered LUTATHERA prior to the expiration date of the Program. The benefit available under the program is valid for the patient’s out-of-pocket cost for LUTATHERA only. It is not valid for any other out-of-pocket costs(eg, office visit charges or medication administration charges) even if such costs are associated with the administration of LUTATHERA.
- If a patient’s insurance benefit year expires during the course of approved program eligibility, confirmation of ongoing treatments and updated insurance information must be received from the treatment facility or physician’s office for eligibility under the program to be continued into the new benefit period.
- The patient is subject to eligibility verification prior to enrollment in the program.
- The patient’s eligibility for the Program expires on the anniversary of the first year following the patient’s initial approval for the program. Thereafter, the patient may re-enroll in the program on a yearly basis. For each re-enrollment period, the patient is subject to eligibility verification.
- Reimbursement under the Program is processed after services are rendered and the appropriate documentation is submitted to the program. Such documentation must be submitted within 365 days after the date of service and must specify a line item specifically for LUTATHERA.
- The benefit conferred by the program is exclusively for the patient.
- The program is not valid where prohibited by law.
- The patient and the patient’s HCP must not seek reimbursement for the benefit conferred by the program from any other party, including without limitation, any health insurance program or plan, flexible spending account, or health care savings account. Providers submitting a claim for assistance on behalf of an eligible patient agree not to charge such patient for any amounts covered by the program.
- The program is not health insurance.
- The program may not be combined with any third-party rebate, coupon, or offer.
- Data related to the patient’s receipt of benefits under the program may be collected, analyzed, and shared with AAA, in an aggregated and patient deidentified form, for purposes that include assessing the program and potentially making adjustments to such program.
- Advanced Accelerator Applications, a Novartis Company, reserves the right to rescind, revoke, or amend the program and/or discontinue assistance at any time without notice.
- No other purchase is necessary.
- Program is limited to 1 per person during this offering period and is not transferable.
AAA PatientCONNECT™ is not an insurance program and is not a substitute for medical insurance.
Receiving Co-pay Financial Assistance
Upon approval, AAA PatientCONNECT™ will send the patient an approval letter and outline of the co-pay assistance funds that are available for their treatment. Proof of treatment and claims must be submitted by the patient to AAA PatientCONNECT™ for the patient to receive a distribution of co-pay assistance funds. Upon receipt, co-pay assistance funds will be processed and distributed to the patient for payment of their LUTATHERA treatment co-pay.
1 Eligibility restrictions apply. For full terms and conditions, please see Enrollment Form.
Co-pay assistance is not available through the AAA PatientCONNECT™ program for patients who have public or government insurance, such as through Medicare, Department of Veterans Affairs, or the Department of Defense.