Coverage, Access, and Support for You and Your Patients
Coverage and Access
PLUVICTO is accessible for most insured patients
A review of claims data between Q1 2023-Q2 2024 indicated that approximately 85% of patients paid $0 for the product. For remaining patients, the out-of-pocket cost for the product varies and may be as high as the total cost of the product. Additional out-of-pocket costs may be incurred related to treatment, including but not limited to administration fees.
Patient Access Lookup Tool
A tool to help you understand plan-specific patient coverage by state, review prior authorization forms, and access payer contact information for PLUVICTO.‡
To see your patient's coverage, access the Lookup Tool now
*Coverage determined based on patients treated with at least one ARPI. The other 20% do not have published policies and/or cases may be determined on an individual basis. Follow up with the patient’s plan to determine coverage.1
†Average PA approval rate for patients when enrolled through the Novartis Patient Support.3
‡This website provides general information and is not intended to provide reimbursement or legal advice. Furthermore, it is not intended to increase or maximize payment by any payer. Because laws, regulations, and coverage policies are complex and updated frequently, you should check with your local Medicare carrier and payers often or go to www.cms.gov .
Nothing in the information provided shall be construed as a guarantee of Novartis regarding levels of reimbursement, payment, or charge that reimbursement will be received. The ultimate responsibility for obtaining reimbursement lies with the physician, provider, or patient. Please consult with your counsel or reimbursement specialist for any practice-specific reimbursement or billing questions.
Novartis Patient Support
Novartis Patient Support is a comprehensive program designed to help your eligible patients start, stay, and save on PLUVICTO
We provide help throughout the insurance and financial process, referral process support, product ordering, and patient navigation.
To get started, complete the Start Form
Download the PLUVICTO Start Form, fill it out, and fax it to 1-844-638-7329
Referral Process Support
Novartis Patient Support can assist providers throughout the referral process.
Use the locator tool to find treatment centers and information about their referral process
Novartis offers treatment centers templated referral checklists & forms (when available)
Our dedicated team can help you navigate the referral process and follow up with treatment centers for enrolled patients
1:1 Patient Navigation
A dedicated team supporting patients and care partners, here to guide your patients through referral, financial assistance, what to anticipate with treatment, and answers to common questions.
Novartis Patient Support does not provide clinical advice or care and is not a substitute for patient consultation with a health care provider.
Patient Navigators can assist treatment centers and referring offices with access, reimbursement, and affordability support. They can also provide 1-on-1 patient education. Phone: 1-844-638-7222
Insurance Support
Once enrolled in Novartis Patient Support, our dedicated team can help navigate the insurance process.
Conduct detailed benefits investigations
Provide support with prior authorization requirements and appeals
Offer coding, billing, and reimbursement education (for treatment centers only)
Financial Support
We offer savings options and resources to help patients access treatment.
To be eligible for the Co-Pay offer, patients must have:
Private insurance
Enrollment in Novartis Patient Support to determine eligibility and participation
Benefit limit of $15,000 over the course of treatment
Product Ordering
PLUVICTO can be delivered within 5 days of order placement,* so your patients can be treated as soon as possible.4
With unconstrained supply, we've increased production for faster, on-time delivery of PLUVICTO to meet current and future demand.
Order PLUVICTO through our electronic ordering portal
Order PLUVICTO directly from Novartis via electronic ordering portal: Place, modify, and track orders in real time through the Novartis Ordering Portal.
Provide live Customer Support with the most common ordering needs. Phone: 1-844-367-3222
†US commercial orders only.
‡Based on claims data and latest HCP location of patients.
Resources
Novartis Patient Support has helpful resources for you and your practice to help support your patients throughout their treatment journey.
Enrollment
PLUVICTO Start Form
Novartis Patient Support Offerings Flashcard
Product Information
PLUVICTO At-A-Glance
LOCAMETZ At-A-Glance
Insurance
PLUVICTO Sample Letter of Appeal
PLUVICTO Sample Letter of Medical Necessity
Co-Pay
Co-Pay Reimbursement Form for Providers
Co-Pay Reimbursement Form for Patients
Reimbursement
PLUVICTO Coding and Billing Guide
LOCAMETZ Coding and Billing Guide
Other Affordability Assistance
Novartis Patient Assistance Foundation, Inc. (NPAF)
Novartis Patient Assistance Foundation, Inc., an independent 501(c)(3) non-profit organization, provides Novartis medications free of cost to eligible patients who have limited or no prescription insurance coverage and cannot afford the cost of their medication.
To be eligible, your patients must:
- Reside in the United States or a US Territory
- Be treated by a licensed US health care provider on an outpatient basis
- Meet income and insurance guidelines
Visit www.PAP.Novartis.com or call NPAF at 1-800-277-2254 to learn more about eligibility and how to apply.