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Support for Your XOSPATA Patients

XOSPATA Support Solutions®, a component of Astellas Pharma Support SolutionsSM, offers access and reimbursement support to help patients address potential challenges to accessing XOSPATA® (gilteritinib).

 

XOSPATA Support Solutions provides information regarding patient healthcare coverage options and financial assistance options that may be available to help patients with financial needs.

 

To speak with a dedicated access specialist, please call us at 1-844-632-9272, Monday–Friday, 8:00 AM–8:00 PM ET.

After the patient has been prescribed XOSPATA, the patient can be enrolled in XOSPATA Support Solutions.a 

There Are 3 Ways to Enroll Your Patient 

  1. Enroll via eRX
    • Submit a prescription for XOSPATA via eRx and select as the pharmacy of choice:
      PharmaCord: 11001 Bluegrass Pkwy, Ste 200, Louisville, KY 40299
      NPI: 1699202838
    • This will initiate the process to enroll in XOSPATA Support Solutions
  1. Enroll by Phone
    • Contact XOSPATA Support Solutions to submit a XOSPATA prescription over the phone 
    • Call 1‑844‑632‑9272, Monday–Friday, 8:00 AM–8:00 AM ET 
    • This will initiate the process to enroll in XOSPATA Support Solutions
  1. Enroll by Fax 
    • Complete the Patient Enrollment Form, including all healthcare provider and patient signatures, and fax it to 1-844-730-8816

XOSPATA Support Solutionsa offers benefits verification assistance to evaluate a patient's insurance coverage for XOSPATA. After performing a benefits verification, we will provide a Summary of Benefits that may include: 

 

  • The patient's insurance coverage for XOSPATA
  • Requirements for prior authorization, step edit, or other coverage restrictions, if any
  • Cost-sharing responsibilities, including the deductible, coinsurance or copayment, and out-of-pocket maximums
  • A list of specialty pharmacies that participate in the patient's insurance plan

The Process

  1. XOSPATA Support Solutions will initiate a benefits verification upon receipt of a XOSPATA prescription or a completed Patient Enrollment Form.
  2. Once benefits verification is complete, we will send a Summary of Benefits.

XOSPATA Support Solutionsa offers prior authorization (PA) assistance upon request by the healthcare provider.

The Process

  1. After determining that a PA is required, XOSPATA Support Solutions will obtain the appropriate PA form.
  2. XOSPATA Support Solutions will transfer solely basic patient and healthcare provider information to the required PA form and send it to the healthcare provider to review, complete, and signb.
  3. XOSPATA Support Solutions will submit the PA form to the insurer if requested by the healthcare provider, or the healthcare provider can submit the PA form directly to the insurer.
  4. XOSPATA Support Solutions will follow up with the insurer to confirm receipt and check status.

Prior Authorization Denial Appeals

If the patient's insurer denies a PA request and the healthcare provider determines that an appeal is appropriate, XOSPATA Support Solutions can assist the healthcare provider with an the appeal process for a denied PA request. 

 

  1. XOSPATA Support Solutions will determine if any additional documentation is required by the patient's insurer. 
  2. XOSPATA Support Solutions will inform the healthcare provider of what information is needed and where to send the appeal.b
  3. The healthcare provider completes and submits the appeal to the insurer.
  4. XOSPATA Support Solutions will track and inform the healthcare provider of the appeal status.

Patient Assistance

XOSPATA Support Solutionsa can provide information about potential programs and patient assistance options that may be available to your XOSPATA patients. 

The XOSPATA Patient Savings Programc is for eligible commercially insured patients taking XOSPATA. Under this program:

  • Patients may pay as little as $0 per prescription 
  • Patients will be enrolled in the program for a 12-month period 
  • Patients have a maximum copay assistance limit of $7,000 per calendar yearc 
  • There are no income requirements 

Enrolling Patients in the XOSPATA Patient Savings Program

Healthcare providers, specialty pharmacies, or patients can fully enroll eligible, commercially insured patients from start to finish in the program. 

Step 1:

Step 2:

  • CONFIRM if you are the HCP or specialty pharmacy enrolling on behalf of your patient

Step 3:

  • ANSWER questions to confirm your patient's eligibility, including their insurance status and place of residence 

Step 4:

  • ATTEST that you have shared the terms and conditions for the XOSPATA Patient Savings Program with the patient. Confirm that the patient has consented to comply with such terms and conditions 

Step 5:

  • PRINT your patient's copay program processing information. If you are the HCP, please send this information to your patient's specialty pharmacy. If you are the specialty pharmacy, please save this information to your patient's records and process the copay program claim accordingly
  • INFORM your patient that they will receive a copy of their copay program details via a mailed letter and email (if provided during enrollment)

The verification, XOSPATA Patient Savings Program information, and next steps will be sent via email, which is why it is very important that your patients or their caregivers have access to an email address.

Healthcare providers may also inform patients that they can enroll themselves in the program by going to XOSPATAcopayenroll.com and selecting the "Patient" option.

For more information or help enrolling in the XOSPATA Patient Savings Program, please call 1-855-221-3493, Monday–Friday, 8:00 AM–10:00 PM ET. Translators are available.

The XOSPATA Patient Assistance Programd (PAP) provides XOSPATA at no cost to patients who meet the program eligibility requirements.

Eligibility Requirements 

XOSPATA Support Solutionsa can assess whether the patient meets the eligibility requirements.

The patient may be eligible if they meet the following criteria: 

  • Are uninsured or have insurance that excludes coverage for XOSPATA,
  • Have a verifiable shipping address in the United States, 
  • Have been prescribed XOSPATA for an FDA-approved indication, AND
  • Meet the program financial eligibility requirements 

Application Process 

Complete the PAP application, including all signatures, and either upload it through the Prescriber Portal or fax it to 1‑844-730-8816. If the patient is eligible for the XOSPATA PAP, we will notify you and the patient, and the XOSPATA prescription will be shipped directly to the patient’s home.

For more information, call 1-844-632-9272, Monday–Friday, 8:00 AM–8:00 PM ET. 

The XOSPATA QUICK START+ Program provides a one-time, 7-day supply of XOSPATA at no cost to eligible new patients who experience an insurance-related delay. 

 

To be eligible for the QUICK START+ Program, patients must: 

  • Have prescription drug insurance 
  • Be new to XOSPATA therapy 
  • Have been prescribed XOSPATA for an FDA-approved indication
  • Have experienced an insurance-related access delay

 

Offers overnight shipping directly to the patient.e

Additional Patient and Caregiver Support

XOSPATA Support Solutions offers additional patient and caregiver support to patients who have been prescribed XOSPATA. This additional support helps connect your patient and their caregivers to educational resources and support based on their particular needs to help them manage their disease and daily life while on treatment. 

When a patient or caregiver calls XOSPATA Support Solutions, a trained representative will assess their specific needs and will conduct a search of various independent local and national organizationsf that may provide the support and resources requested. 

Additional patient and caregiver support resources may include: 

Emotional Support

  • Social workers, counseling services, or online communities for patients
  • Emotional support for the caregiver

Logistical Support

  • Transportation and lodging assistance for treatment
  • Help with other day-to-day tasks

Informational Support

  • Education and resources
  • Information on nutrition and self-care

Patients and their caregivers can call XOSPATA Support Solutions at 1-844-632-9272, Monday–Friday, 8:30 AM–8:00 PM ET, to learn about potential resources offered.

Pharmacies and Distributors

XOSPATA prescriptions are filled through specialty pharmacies or practices with in-office dispensing pharmacies.

Specialty pharmacies typically mail the patient's prescription directly to the patient. There are physician practices that may elect to dispense XOSPATA through their in-office dispensing pharmacies.

If you have any questions, please call XOSPATA Support Solutions at 1-844-632-9272. We are available Monday–Friday, 8:00 AM–8:00 PM ET.

XOSPATA Network Specialty Pharmacies
Pharmacy Phone Number  Fax Number 
Biologics 1-800-850-4306 1-800-823-4506 
Onco360 1-877-662-6633
 1-877-662-6355 
CVS Specialty Pharmacy 
 1-866-388-7656  1-855-296-0210
Specialty Pharmacies for Puerto Rico 
Pharmacy Phone Number  Fax Number 
Special Care Pharmacy Services 1-787-783-8579 1-787-783-2951

Practices with in-office dispensing pharmacies may order XOSPATA through the network of specialty distributors below.

Specialty Distributors for Dispensing Physician Practices
Distributor
 Phone Number  Fax Number 
ASD Healthcare 1-800-746-6273 1-800-547-9413
Cardinal Health Specialty Distribution 1-855-740-1871 1-888-345-4916
McKesson Plasma and Biologics, LLC 1-877-625-2566 1-888-752-7626 
McKesson Specialty Health  1-800-482-6700 1-800-800-5673
Oncology Supply 1-800-633-7555 1-800-248-8205
Specialty Distributors for Puerto Rico 
Pharmacy Phone Number  Fax Number 
Cesar Castillo, Inc. 1-787-999-1616
 1-787-999-1618

aXOSPATA Support Solutions is a component of Astellas Pharma Support SolutionsSM.

 

bThe healthcare provider remains responsible for populating all clinical information.

 

cBy enrolling in the XOSPATA Patient Savings Program ("Program"), the patient acknowledges that they currently meet the eligibility criteria and will comply with the following terms and conditions: The Program is for eligible patients with commercial prescription insurance coverage for XOSPATA® (gilteritinib) and is good for use only with a valid prescription for XOSPATA. The Program is not valid for patients whose prescription claims are reimbursed, in whole or in part, by any state or federal government program, including, but not limited to, Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, Puerto Rico Government Insurance, or any state patient or pharmaceutical assistance program. Patients who move from commercial insurance to federal or state health insurance will no longer be eligible, and agree to notify the Program of any such change. Patients agree not to seek reimbursement from any health insurance or third party for all or any part of the benefit received by the patient through the Program. This offer is not conditioned on any past, present, or future purchase of XOSPATA. This offer is not transferrable and cannot be combined with any other offer, free trial, prescription savings card, or discount. The full value of the Program benefits is intended to pass entirely to the eligible patient.

 

This offer is not health insurance and is only valid for patients in the 50 United States, Washington DC, Puerto Rico, Guam and Virgin Islands. This offer is not valid for cash paying patients. This Program is void where prohibited by law. No membership fees. It is illegal to sell, purchase, trade, counterfeit, duplicate, or reproduce, or offer to sell, purchase, trade, counterfeit, duplicate or reproduce the card. This offer will be accepted only at participating pharmacies. Certain rules and restrictions apply. Astellas reserves the right to revoke, rescind, or amend this offer without notice. The Program has a maximum copay assistance limit of $7,000 per calendar year. After the annual maximum on copay assistance is reached, patient will be responsible for the remaining out-of-pocket costs for XOSPATA. Astellas may reduce or discontinue the copay assistance available under the Program if it determines an enrolled patient is subject to a program offered by a third-party payer or pharmacy benefit manager, or an agent of either, that adjusts patients’ out-of-pocket cost-sharing obligations based on the copay assistance provided by this Program, or excludes the copay assistance provided under this Program from counting towards an enrolled patient’s out-of-pocket cost-sharing obligations (“maximizer” or “accumulator” program). The Program uses advanced logic to identify whether a claim for an enrolled patient is subject to a “maximizer” or “accumulator” program. Unless prohibited by law, Astellas may reduce the cost-sharing assistance available under the Program to a per claim maximum of $25 if it determines a claim for an enrolled patient is subject to a “maximizer” or “accumulator” program.

 

dSubject to eligibility criteria. Terms and conditions apply. Void where prohibited by law.

 

eProvided request is submitted by 2:00 PM ET.

 

fSupport is provided through third-party organizations that operate independently and are not controlled or endorsed by Astellas. Availability of support and eligibility requirements are determined by these organizations.

 

 

QUICK START+® and XOSPATA® are registered trademarks of Astellas US LLC.