Reimbursement Certification

Question 1

What insurance plans have Palforzia on their formulary?

Answer 1

Palforzia is a newly launched product therefore there is no initial coverage right out of the gate. Aimmune is highly dedicated to helping your pts gain access to Palforzia and I would like to discuss those options with you.

Question 2

What type of paperwork will we potentially need to complete to get Palforzia covered?

Answer 2

• Prior Authorizations(PA)
• Medical Exception(ME)

CoverMyMeds is another tool that many offices are familiar with to streamline the PA process.

Question 3

Do you have a co-pay program?

Answer 3

Yes, Palforzia Pathway Co-pay savings program is available as long as the patient has commercial insurance and meets additional criteria. If approved the patient may pay as little as $20/per month for Palforzia

Question 4

What about patients without insurance?

Answer 4

Yes, we have a platform call the Palforzia Pathway Patient Assistance Program(PAP)

• Available to patients who are uninsured or have been deemed uninsured due to payer denial for Palforzia.
• Patient must meet certain financial eligibility requirements
• Requires valid on label rx

Question 5

What is the process for submitting a Rx for Palforzia?

Can pt have Rx filled at a local pharmacy?

Answer 5

Steps for ordering a Rx of Palforzia:

1) HCP submits Rx
2) SP verifies patient and HCP enrollment in REMS(Risk Evaluation Metigation Strategy)
3) HCP obtains payer approval
4) Eligible patients learn about financial assistance options
5) SP coordinates shipment and collects patient co-payment
6) SP ships Palforzia to HCP office

Aimmune has a network of REMS certified Specialty Pharmacies which consist of Walgreens, CVS and Optum for which Palforzia Rx’s will be filled through upon launch.

Question 6

What about Medicaid patients?

Answer 6

Medicaid prescriptions should be submitted via our Palforzia Pathway Program or to one of our 3 REMS Certified Specialty Pharmacies.