AccessPlus: Reimbursement support services with a streamlined process easily integrated into your patient processing system

ILUVIEN AccessPlus supports your practice by offering comprehensive services built around your needs

The ILUVIEN AccessPlus program steps:

  1. Prescribing physician enrolls one time with a simple, one-page Prescriber Enrollment Form
  2. Patient Enrollment Form
    • The enrollment form collects information needed for coverage coordination (benefits investigation, prior authorization, product acquisition options, financial assistance)
  3. You receive a Summary of Patient Benefits for each patient benefits investigation with detailed information on ILUVIEN coverage for your patient

ILUVIEN AccessPlus is available to you.

Alimera Sciences is committed to supporting your practice. Dedicated Reimbursement Account Specialists are available to partner with you as you navigate the ILUVIEN reimbursement process.

PHONE

1 844 445 8843, Option 3

AccessPlus Case Managers
are available Monday-Friday,
8 AM-6 PM EST

FAX

1 844 501 7161

Benefits investigation

To provide your patients with coverage for ILUVIEN

  • Patient-specific benefits investigation
  • Summary of Patient Benefits provided within 48 hours*
  • Prior authorization requirements with payer-specific processes and forms provided
  • Patient out-of-pocket responsibility and financial assistance options for ILUVIEN

Reimbursement support

  • A regional reimbursement account specialist for dedicated and proactive reimbursement support

To provide guidance and assistance for patient coverage scenarios

  • Coding and billing guidance
  • Prior authorization assistance
  • Claims follow-up
  • Appeals support
  • Specialty pharmacy prescription referral routing and follow-up

Reimbursement support materials

Sample CMS 1500
Claim Form

Sample CMS 1450/UB-04
Claim Form

Sample Letter of
Medical Necessity

Sample Letter
of Appeal

Financial assistance resources

To help your patients with their out-of-pocket costs for ILUVIEN

  • ILUVIEN CoPay Program for commercially or privately insured patients with a financial need
    • Patient out-of-pocket costs capped at $25
  • Referral to independent non-profit foundation for government-insured patients in need of copay assistance
  • ILUVIEN Patient Assistance Program provides free drug for qualified uninsured and rendered uninsured patients

Product acquisition flexibility

To provide acquisition options best suited for your patients and practice

  • Specialty distributors for the buy-and-bill process
    • Besse Medical Ophthalmology
    • McKesson Specialty Health
  • Specialty Pharmacy Network
  • Replacement Program if ILUVIEN is prescribed per FDA label and you are unable to administer it

Additional AccessPlus information and forms

Summary Overview
of AccessPlus

Patient Enrollment Form
Patient Assistance Application

Prescriber
Enrollment Form