Understanding Your Coverage
for Niktimvo™ (axatilimab-csfr)
When you have a new prescription or a new insurance plan, navigating the details of what’s covered can be stressful. A representative from our team can help walk you through it, so you can focus on taking care of yourself.
Here’s how we help eligible patients enrolled in IncyteCARES:
We receive your prescription and insurance information.
This information is included on your IncyteCARES program enrollment form. If you’re already enrolled in the program, you can call us directly to report any insurance changes and request help.
A team member will contact your insurance company.
We will:
- Find out if your plan will cover Niktimvo and how much you may need to pay out of pocket
- Determine whether your insurer requires a prior authorization before approving coverage (Many plans require this!)
What is a prior authorization?
If your insurance company requires a prior authorization, it means they require your Healthcare Professional to send them more information about your health condition and why Niktimvo has been prescribed. Based on the additional details, they will determine your coverage. Some insurers call this process precertification or prior approval. Many prescription drug insurers require prior authorization for Niktimvo.
These steps usually take up to 3 business days to complete.
We call you to review the information for your insurer.
On this call, we can also explain any savings or financial assistance programs* that may be available to you.
If coverage is approved
- We can coordinate with your transplant center to ensure that your Niktimvo is ready and waiting when you arrive for your infusion
If coverage is delayed because prior authorization is required
- You don’t need to take any action
- We notify your Healthcare Professional of this requirement and what’s needed
- Your Healthcare Professional will send the required information to your insurer
- We monitor the process, and communicate as needed with your Healthcare Professional and insurance company, until a coverage decision is made
- On our call with you, we’ll share information about the status of your prior authorization and estimated timing on when to expect a coverage decision. (It usually takes just a few days.) We can also share your estimated out-of-pocket costs for Niktimvo
- In most cases, your insurer will approve your coverage. Then, we can help with coordinating the delivery of your Niktimvo
If coverage is denied
- Your insurer will notify you and your Healthcare Professional by mail with an explanation for the denial
- We will provide information about how you and your Healthcare Professional can file an appeal on your behalf and have it reviewed by an independent third party as required by law
- Once your Healthcare Professional submits the appeal, we will monitor the process, and communicate as needed with them and with your insurance company, until a final coverage decision is made
- You don’t need to take any action. On our call with you, we’ll share information about the status of your appeal, and if available, estimated timing on when to expect a final decision from your insurer
- Your insurer will notify both you and your Healthcare Professional by mail of their appeal decision
- If the appeal is unsuccessful (coverage is denied), we can assess your eligibility for a financial assistance program*
- If your appeal for coverage is approved, we can help with coordinating the delivery of your Niktimvo
