What is the GlaxoSmithKline Reimbursement Resource Center (GSKRRC)?
What services are available through the GSKRRC?
What services are included under Verification of Benefits/Payer Research?
What services are included under Denied/Underpaid Claims and Appeals Assistance?
What services are included under Prior Authorization Assistance?
What services are provided through Coding Assistance?
What services are included under Alternate Funding/Coverage Research?
Does the GSKRRC provide reimbursement assistance related to any payer?
How do callers contact the GSKRRC, and what are the days and hours of operation?
Is there a patient authorization form for cases involving patient-specific research?
What is the cost to callers for using the GSKRRC?
Do the "Oncology Reimbursement HELPline" and "ARIXTRA Reimbursement Hotline" still exist separately, or are they now part of the GSK Reimbursement Resource Center?

1.  What is the GlaxoSmithKline Reimbursement Resource Center (GSKRRC)?

The GlaxoSmithKline Reimbursement Resource Center is a toll-free reimbursement hotline designed to assist patients and healthcare professionals with coverage, reimbursement, and coding issues related to all payers for most GSK products. A complete list of supported products and prescribing information is available by clicking here.

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2.  What services are available through the GSKRRC?

The GSKRRC offers a wide range of reimbursement support services for patients and healthcare professionals. The following services are available:

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

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3.  What services are included under 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).

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.

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4. What services are included under Denied/Underpaid Claims and Appeals 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.

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5. What services are included under 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.

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6. What services are provided through 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.

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7. What services are included under Alternate Funding/Coverage Research?

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.

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8. Does the GSKRRC provide reimbursement assistance related to any payer?

The GSKRRC is available to assist callers with reimbursement inquiries for GSK products related to all payers, including:

• Medicare
• Medicaid
• All private payers
• Veterans Affairs
• TRICARE
• AIDS Drug Assistance Programs (ADAPs)
• State Children's Health Insurance Programs (SCHIPs)
• State Pharmaceutical Assistance Programs (SPAPs)
• Other federal, state, or local payers

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9. How do callers contact the GSKRRC, and what are the days and hours of operation?

Experienced reimbursement agents are available Monday through Friday from 9:00 am to 6:00 pm Eastern Time by calling 1-800-745-2967. Voice messaging is available after hours during the week, as well as on weekends and holidays. All voice mail messages are returned no later than the following business day.

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10. Is there a patient authorization form for cases involving patient-specific research?

Patients must sign and return the Patient Authorization to Disclose and Release Medical Information Form before the GSKRRC can contact the patient's insurer, or otherwise initiate any patient-specific research. Signed forms may be faxed to 866-216-5292 or mailed to the GSK Reimbursement Resource Center, P.O. Box 221425, Charlotte, NC 28222-1425.

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11. What is the cost to callers for using the GSKRRC?

The GSKRRC is free of charge to callers.

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12. Do the "Oncology Reimbursement HELPline" and "ARIXTRA Reimbursement Hotline" still exist separately, or are they now part of the GSK Reimbursement Resource Center?

Effective June 27, 2005, GSK consolidated the Oncology Reimbursement HELPline, ARIXTRA Reimbursement Hotline and the GSK Reimbursement Resource Center under one program. The consolidated program is branded under the name GSK Reimbursement Resource Center.

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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.