SAPHNELO Supports Enrollment Form

Download and complete the SAPHNELO Supports Enrollment Form to request support for your patients.

SAPHNELO Access and Reimbursement Guide

This guide contains general information on dosing, distribution, support services, and reimbursement for SAPHNELO.

SAPHNELO J-Code: J0491

SAPHNELO Coding Resource

This resource provides specific codes related to diagnosing and billing for SAPHNELO.

SAPHNELO J-Code: J0491

The Policy Acumen Portal provides up-to-date resources for billing, coding, and coverage policies specific to SAPHNELO for preselected payers.

SAPHNELO Acquisition Distribution Sheet

This sheet provides the contact information of authorized Specialty Pharmacy Providers and Specialty Distributors, from which SAPHNELO can be obtained.

SAPHNELO Savings Program Affordability Information

A two-page resource describing ways in which patients can pay for SAPHNELO if it is approved or denied.

SAPHNELO Denied Patient Savings Program Form

A single-page form for providers to complete in the event that a patient has been denied SAPHNELO.

SAPHNELO Prior Authorization and Appeal Checklists

Checklists designed to be used as references during the prior authorization (PA) and denial/appeal processes for SAPHNELO.

SAPHNELO Sample Appeal Letter

This template can be used by a healthcare provider to appeal a denial of access to SAPHNELO.

SAPHNELO Sample Appeal Letter - Product Change

This template can be used by a healthcare provider to appeal a denial of access to SAPHNELO.

SAPHNELO Sample Letter of Medical Necessity

This template is offered as a resource that a healthcare provider could use when responding to a request from a patient’s insurance company to provide a letter of medical necessity for prescribing SAPHNELO.