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Specialty Pharmacy
Reimbursement Map Information

Select a state and commercial payer to view specialty pharmacy requirements and access specific prior authorization and order forms.

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Plan Requirements Result(s): 0

Commercial Payer:

State:

Specialty Pharmacy Policy:

Please note that the use of Specialty Pharmacy varies by health plan. The following key will help you better understand the specialty pharmacy policy for your patient’s specific health insurance plan.

B&B Only – Buy and Bill
Mandatory – Use of preferred SPP is required
policy for your patient’s specific health insurance plan.
Optional – Physician can use network SPP or Buy & Bill
Optional/Preferred – SPP & Buy & Bill allowed; if SPP, must use preferred SPP
Preferred – Physicians are encouraged to use preferred SPP only

Prior Authorization:

Payer Notes:

 

This reimbursement material represents Sanofi's current understanding. Many topics covered in this guide are complex and all are subject to change beyond our control. Healthcare professionals are responsible for keeping current and complying with reimbursement policy and regulations. This information is not intended to be directive, nor does the use of the recommended codes guarantee reimbursement. Providers should select the codes that most accurately reflect the patient's medical condition, payer requirements, practice patterns and services rendered. Providers are responsible for the accuracy of any claims, invoices and related documentation submitted to payers.

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