The GSK Reimbursement Resource Center is available to assist patients and healthcare professionals with the following coverage, coding, and reimbursement issues:

• Verification of Benefits/Payer Research
• Denied and Underpaid Claims Assistance
• Prior Authorization Assistance
• Coding Assistance
• Alternate Funding Search

Verification of Benefits/Payer Research

At the request of a patient or healthcare professional, the GSKRRC will contact a patient's insurer and verify specific coverage and reimbursement benefits for GSK products. This service helps educate patients and providers about the following:

• Drug coverage;
• Drug administration coverage (i.e., a physician-administered injectable);
• Prior authorization requirements;
• Other restrictions or requirements under the patient's plan (i.e., capitation limits, quantity limits, pre-existing conditions);
• Reimbursement methodology for covered drugs and related services (i.e., chemotherapy administration, anti-emetic administration);
• Patient co-payment responsibilities; and
• Patient options for obtaining the drug (i.e. retail pharmacy; mail order; medical benefits for IV products).

See the following examples of patient and provider questions that the GSKRRC can help answer.

Examples of Patient Questions

• "Is my prescription for [GSK Drug] covered by my insurance? "
• "Do I need to obtain prior authorization?"
• "What quantity of drug is covered per month/year? Do I have a monthly cap?"
• "What are my copay/deductible responsibilities?"
• "Do I have mail order and retail pharmacy options?"

Examples of Healthcare Professional Questions

• "Is [GSK drug] covered under my patient's prescription drug rider?"
• "What "J" code should we use to bill Medicare Part B for [GSK Drug]?"
• "What is the reimbursement rate for the drug under my patient's plan?"
• "Does Medicare or Medicaid cover this drug when administered in a physician's office or outpatient hospital setting?"

Denied and Underpaid Claims Assistance

Researching denied or under-reimbursed claims is an important check to ensure that payers cover all appropriate benefits allowed under a plan. At the request of a patient or healthcare professional, the GSKRRC can assist by providing the following services:

• obtaining copies of applicable claims, explanation of benefits, appeals judgments, and other relevant documentation for review
• thoroughly reviewing claim, EOB, and/or contacting the insurer (if necessary) to determine the reason for the denial or underpayment;
• advising the patient or healthcare professional why the claim was denied or underpaid;
• advising the patient or healthcare provider of the corrective measures needed, if any, to obtain appropriate coverage or payment as directed by the patient's insurer.
• providing limited assistance with appeals for oncology products as appropriate; and,
• communicating outcome of appeals request back to prescriber and/or patient.

Prior Authorization Assistance

At the request of patients and healthcare professionals, the GSKRRC can provide the following prior authorization assistance:

• verify specific prior authorization requirements required by payers for applicable drugs and patients;
• provide payer-specific forms when applicable;
• assist patients and prescribers with information required for prior authorization submissions to payers; (i.e., letters of medical necessity templates for oncology products, supportive literature)
• assist with submission of prior authorization request to payers (oncology products only);
• monitor prior authorization process and communicate results back to patient or healthcare professional.

Coding Assistance

Coding and billing requirements for prescription drugs, especially physician-administered drugs, varies significantly by payer, setting of care, and can also change from year-to-year. The GSKRRC can help educate healthcare professionals about current coding requirements related to GSK products by providing information related to the following coding systems:

• HCPCS Codes (i.e., "A" codes, "C" codes, "J" codes) for certain drugs;
• CPT^‡ codes for medical services/and procedures (i.e., drug administration)
• ICD-9 diagnosis and procedure codes; and
• National Drug Codes (NDCs).

Note: Coding requirements are reported based on information obtained by the GSKRRC from the Centers for Medicare & Medicaid Services, the American Medical Association, Medicare contractors, Medicaid programs, private insurers/MCOs, and other payers.

All final coding decisions are the responsibility of the patient's physician and billing staff based on the patient's medical condition and services rendered. The GSKRRC does not file claims for providers.

Alternate Funding Search

GSK occasionally receives calls from uninsured or underinsured patients looking for assistance in obtaining their GSK medications. The GSKRRC helps determine if patients are eligible for any local, state, and federal prescription drug assistance programs. Additionally, the GSKRRC can refer eligible patients to one of the drug discount card or patient assistance programs sponsored by GSK.

Once a viable match is identified, the GSKRRC will send information about the payer/program to the patient so he/she may apply for assistance.

How to Request Assistance

Assistance may be requested by calling 800-745-2967, or by faxing a Benefit Verification Request Form to 866-216-5292.

Before the GSKRRC can begin patient-specific research, patients must sign and return the Patient Authorization to Disclose and Release Medical Information Form. The Patient Authorization to Disclose and Release Medical Information Form is page 2 of the Benefit Verification Request Form, and is also available as a stand-alone form.

IMPORTANT NOTICE: GlaxoSmithKline does not guarantee or provide any explicit or implicit warranty of coding, coverage, or reimbursement. Coding, coverage and reimbursement policies vary significantly by payer, patient, and setting of care. Actual coverage and reimbursement decisions are made by individual payers following the receipt of claims. GSK strongly recommends verifying coverage, coding, and reimbursement guidelines on a payer and patient-specific basis.

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^‡CPT is a trademark of the American Medical Association. All CPT^® five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines, and other material are the Copyright of the American Medical Association.