KabiCare Patient Support Program forOTULFI^® (ustekinumab-aauz)

Benefits Investigation

Once a patient is enrolled, KabiCare conducts the benefits investigation on behalf of the patient to confirm insurance coverage details. The information is provided to you, your practice, and your patient to aid in patient access.

Prior Authorizations Support

If a prior authorization is required by insurance, the Patient Support Guide will alert your office of the requirement and confirm the submission method preferred by the payer. The Patient Support Guide will work closely with you and your staff to ensure the appropriate information is shared with the payer.

Claims Appeals Support

Should a claim or prior authorization be denied, a KabiCare Patient Support Guide will assist as you prepare the documentation needed to support an appeal.

1. Download Sample Letter of Medical Necessity (PDF Opens in a New Window)
2. Download Sample Letter of Appeal (PDF Opens in a New Window)

Obtaining a determination from the insurance company is sometimes delayed for any number of reasons. Field Reimbursement Managers will be available to help identify and overcome obstacles in an effort to prevent any further delays.

Billing and Coding Support

Get connected with a Field Reimbursement Manager who is available to share updates in payer coverage and help answer your questions about billing and coding.

Download: Access and Reimbursement Guide (PDF Opens in a New Window)

Bridge to Therapy Program Enrollment

The Bridge to Therapy Program provides commercially insured patients access to treatment without delay while they are waiting for insurance approval. Eligibility criteria apply**.

**Eligibility criteria apply. Patients are not eligible for commercial copay assistance or Bridge to Therapy support if the prescription is eligible to be reimbursed, in whole or in part, by any state or federal healthcare program.

Specialty Pharmacy Support

If you enrolled your patient, or the patient enrolled themselves into the KabiCare Patient Support Program, and a specialty pharmacy was not selected, the Patient Support Guides can help ensure your patient’s prescription is triaged to an appropriate specialty pharmacy.

Commercial Copay Support

If your patient has commercial or private insurance, they may be eligible** for the copay program that lowers their out-of-pocket costs to as little as $0/month for treatment with an annual maximum. Your patient will have a choice to enroll in the full KabiCare Patient Support Program, or just simply enroll in OTULFI Copay Support.

Enroll in the full Program (PDF Opens in a New Window)
Enroll your patient in the Copay Program ONLY

Patient Assistance Program

If your patient does not have insurance or does not have coverage for their medication, they may be eligible for additional assistance through the Patient Assistance Program * or through independent nonprofit patient assistance programs. Eligibility criteria apply.‡

*Terms and conditions apply

**Eligibility criteria paply. Patients are not eligible for commercial copay assistance or Bridge to Therapy support if the prescription is eligible to be reimbursed, in whole or in part, by any state or federal healthcare program.

‡Eligibility for resources provided by independent nonprofit patient assistance program sis based on the nonprofits’ criteria. Fresenius Kabi has no control over these programs.

Financial Assistance Resources

Non-Profit Foundations for Financial Assistance

Nurse Support

Once enrolled, KabiCare Nurse Educators are available to help your patient make sense of their disease, treatment and medication as prescribed by you. Nurse Educators will also be available to provide injection training for your patients by phone or telehealth. Nurse support provided by KabiCare is not meant to replace discussions with a healthcare provider regarding a patient’s care and treatment.