Evrysdi Coverage

Insurance Benefits Investigations Prior Authorization Evrysdi Start Program

Insurance Benefits Investigations

MySMA Support for Evrysdi can conduct an insurance benefits investigation (BI) to help you determine if Evrysdi is covered, if prior authorizations (PAs) are required and if financial assistance might be needed.

Potential outcomes of an insurance BI:

Treatment is covered
PA is required
Treatment is denied

Once the insurance BI is complete, your Partnership and Access Liaison (PAL) will walk your patient through his or her insurance coverage for Evrysdi.

An insurance BI may be initiated once the Evrysdi Start Form is submitted to MySMA Support.

This form can be downloaded from Forms and Documents.

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and health care provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.

Prior Authorization

Your Neurological Rare Disease Account Manager (NRD AM) or Case Manager (CM) can identify the required prior authorization (PA) forms and documents for submission to the health insurance plan and provide general resources to help you submit a PA. Once your practice has submitted a PA, your NRD AM or CM can follow up with the payer regarding the PA status. Remember, submitting the PA is the responsibility of the practice. PA support may be provided once the Evrysdi Start Form is submitted to MySMA Support for Evrysdi.

If your patient's request for a PA is not granted, your NRD AM or CM can work with you to determine your next steps. You can find more tips like this in Forms and Documents.

Evrysdi Start Program

The Evrysdi Start Program may help people who have been prescribed Evrysdi begin treatment as soon as possible by providing short-term, free medication. The Evrysdi Start Program is available for insured people who have been prescribed Evrysdi and are experiencing a delay in insurance approval. Eligible patients may receive up to 2 shipments of Evrysdi.

If you believe your patient qualifies for the Evrysdi Start Program, please submit the completed Evrysdi Start Form and check the Starter section (Section 6) on page 6 (the Prescriber Service Form). As a reminder, page 4 of the Start Form (the Patient Consent Form) must also be completed and submitted to enroll a patient into the Evrysdi Start Program. For more information, please contact your Evrysdi representative.

Subject to eligibility requirements and terms and conditions. This program is void where prohibited by law and may not be used in or by residents of restricted states, if applicable.

For assistance, call (877) GENENTECH/(877) 436-3683
6 a.m.–5 p.m. PT, Monday through Friday

To enroll in MySMA Support, complete and submit the Evrysdi Start Form