Navigating coverage for treatment with GAMIFANT® (emapalumab-lzsg)

Obtaining approval for your patient’s treatment may require your institution to complete several steps, including conducting a thorough benefits investigation to determine if a prior authorization or medical exception is needed. Our Gamifant Patient Services team is available to help explain these processes at 833.597.6530.

Coverage resources

Sobi has developed a library of resources to help you and your institution navigate the insurance approval process for Gamifant.

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Overview of Gamifant

Gamifant Product Fact Sheet

A high-level overview, including relevant product codes

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Gamifant Clinical Overview

Information about studies with Gamifant

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Access and Reimbursement

Tips for Completing a Benefits Investigation

A guide to review the process

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Understanding Your Patient's Medical and Pharmacy Benefits

Information about different types of coverage

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Guide to Prior Authorization Submission

Details about the process and submission of documentation to gain approval

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Summary of Relevant Codes for Gamifant

A consolidated checklist

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Requesting a Medical Exception for Gamifant

Guidance for submission and appealing denial of coverage

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Sample Letter of Medical Necessity

Sample Letter

A downloadable template that can be tailored to your patient and submitted to health insurance plans to request approval for Gamifant

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Pharmacy and Office Resources

Provider Contact Sheet

A customizable PDF to track communications with insurance companies and ensure timely follow-up

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It is the provider's responsibility to determine the appropriate healthcare setting and to submit true and correct claims for those products and services rendered. Providers should contact third-party payers for specific information on their coding, coverage, and payment policies.