Savings & Support

• Discuss the process and timeline from prescription to injection
• Help patient understand her out-of-pocket costs
  • Deductibles may make out-of-pocket costs higher
  • High-deductible plans may have lower monthly premiums but higher out-of-pocket deductibles
• Encourage patient to download her LUPRON DEPOT^® or Add-back* Savings Card^†
• Remind patient to respond promptly to calls from the specialty pharmacy or RxCrossroads, or AbbVie Insurance Specialist services, agree to delivery of medication, and provide payment
• Reiterate importance of starting and staying on therapy
  • Keeping the appointment for the first injection
  • Continuing physician- or provider-directed treatment for the entire course of therapy

*Norethindrone acetate 5 mg daily.

^†Eligibility restrictions may apply. See LUPRON DEPOT or LUPRON DEPOT + Add-back* Savings Card for details.

• Ensure you receive Prior Authorization (PA) form from RxCrossroads or AbbVie Insurance Specialist
  • Even if using RxCrossroads or PA form may come from managed care plan, pharmacy benefits manager (PBM), or specialty pharmacy
  • Ensure the correct form is received from managed care plan or PBM
• Confirm all information is correct and complete, and sign the form
  • Know the indication-based requirements and clinical criteria of the health plan
  • Confirm rationale for use meets all plan criteria
  • Gather required supporting information
• RxCrossroads or AbbVie Insurance Specialist will direct you where to send the PA and supporting documentation on the Statement of Benefits
  • Send a copy of PA and supporting documents to RxCrossroads or AbbVie Insurance Specialist

• Promptly respond to all information requests to avoid delays
• Investigate reasons for denials
  • If denial letter received, ask service to investigate
  • If reason for denial not provided, ask service to investigate
• Gather required information needed to respond or appeal
• Resubmit the completed, corrected, and signed documents to the requesting entity
• Keep a log of all pending requests and need for follow-up with service

• Ensure RxCrossroads, AbbVie Insurance Specialist, MHC Plan, and/or Specialty Pharmacy has all necessary paperwork, such as referral, approved PA
• Remind patient to respond to calls from specialty pharmacy or service, agree to delivery of medication, and provide payment
  • Ensure that eligible patients use LUPRON DEPOT or LUPRON DEPOT + Add-back* Savings Card^†

*Norethindrone acetate 5 mg daily.

^†Eligibility restrictions may apply. See LUPRON DEPOT or Add-back* Savings Card for details.

criteria may vary by plan

1. A diagnosis of endometriosis

2. Initial treatment of endometriosis, not to exceed 6 months

3. Retreatment of endometriosis, not to exceed 6 months

4. Suspected endometriosis

5. Management of endometriosis, including pain relief. Reduction of endometriotic lesions for LUPRON DEPOT.

6. Endometriosis confirmed by laparoscopy and resistant to first-line treatment in females 18 years of age and older

7. Endometriosis not confirmed by laparoscopy when other potential causes have been excluded

*Norethindrone acetate 5 mg daily.

criteria may vary by plan

1. Diagnosis of fibroids

2. Diagnosis of anemia due to uterine fibroids, including previous treatment with iron therapy

3. Must be administered in conjunction with iron therapy

4. Preoperative hematologic improvement of patients with anemia due to heavy bleeding caused by uterine leiomyomata, preceded by a 1-month trial of iron therapy alone