Lilly Oncology is committed to helping your patients access the care they need
Lilly is dedicated to developing medicines that make life better. We support patients as well as those who look after and care for them. We’re determined to do our part to help patients and their loved ones.
That’s why we created the Lilly Oncology Support Center—a consolidation of all the support resources available to you and the patients you treat with ALIMTA® (pemetrexed for injection), CYRAMZA® (ramucirumab), ERBITUX® (cetuximab), Portrazza® (necitumumab), or Verzenio® (abemaciclib). That means you and your patients can access all the support resources you need via a single program.
Through the Lilly Oncology Support Center, we strive to offer individualized treatment support for eligible patients prescribed a Lilly Oncology product.
For those who qualify, we can help with:
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Review of financial-assistance options:
- Savings card programs
- Independent patient-assistance foundations
- Reimbursement (eligibility determination, benefits investigation, prior authorization assistance, and appeals information)
Enroll Your Patient in the Lilly Oncology Support Center Programs
Verzenio Continuous Care™ Support Program:
FINANCIAL ASSISTANCE
Through the Lilly Oncology Support Center Savings Card program, commercially insured qualified patients pay as little as $0 (depending on the product) for their prescribed medication. There are no income requirements. There is a $25,000 annual maximum benefit.
This offer is invalid for patients whose prescription claims are eligible to be reimbursed, in whole or in part, by any governmental program. So if your patients are covered by Medicaid, Medicare Part D, TRICARE®, or any other state or federal program, they don’t meet the eligibility requirements.
Savings Card Eligibility Criteria†
ELIGIBLE
- Patients must be aged 18 years or older
- Patients must be residents of the United States or Puerto Rico
- Patients must be treated with ALIMTA, CYRAMZA, ERBITUX, Portrazza, or Verzenio for an FDA-approved indication
- Patients must be commercially insured‡
INELIGIBLE
- Patients enrolled in Medicaid, Medicare, Medigap, CHAMPUS, DoD, VA, TRICARE®, or any state, patient, or pharmaceutical assistance program
- Patients enrolled in any other financial support program, discount, discount card, or incentive program involving ALIMTA, CYRAMZA, ERBITUX, Portrazza, or Verzenio
- Patients, pharmacists, and prescribers must not seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this program
†This offer is invalid for patients without commercial insurance coverage or those whose prescription claims are paid by Medicare Part D, Medicaid, TRICARE® or any other state or federal program. Offer void where prohibited by law and subject to change or discontinuance without notice. Restrictions, including annual maximums, may apply. Card activation required.
‡Please see full terms and conditions for infused products.
Field Reimbursement Managers available through the Lilly Oncology Support Center
Lilly Field Reimbursement Managers can provide information and education to help navigate the access and reimbursement landscape. We’re here to help make access to prescribed Lilly Oncology products easier for patients.
If you have questions or want to learn more, call 1-866-472-8663, Monday - Friday, 8AM – 10PM ET.
OTHER TOOLS AND RESOURCES
Find other resources that may help you assist patients with reimbursement
When insurance isn’t enough to pay for cancer treatment, there are other resources that may help address the financial challenges and access issues that some patients experience.
Lilly Cares Foundation
The Lilly Cares Foundation, Inc., a separate nonprofit organization, provides free Lilly medicines to qualifying patients. For more information about Lilly Cares, please visit LillyCares.com.
Independent Patient Assistance Program Foundations
There may be a way to help your underinsured patients get the treatment they need with less financial stress. If your patients can’t afford their co-pay or coinsurance, the Lilly Oncology Support Center provides information about a number of independent patient assistance programs that may be able to help eligible patients. These foundations are not affiliated with Eli Lilly and Company and have been established and are operated independently. Please remember, funding availability changes weekly, so contact a Lilly Oncology Support Center representative at 1-866-472-8663 for the most recent updates.
BILLING AND CODING
Via the links below, arranged by product name, you’ll find billing codes and information related to ordering products.
Choose a product:
ADDITIONAL RESOURCES
Find the resources you need to navigate the appeals process
There are other tools and resources that can help as you work through the ordering, billing, reimbursement, and appeals processes.
Coding
American Medical Association: CPT® Current Procedural Terminology
A resource maintained by the CPT Editorial Panel to help you better understand the latest CPT codes and coding issues.
HCPCS (Healthcare Common Procedure Coding System) Codes: CMS
The Centers for Medicare & Medicaid Services (CMS) provides a website with coding and process information as well as modifications you should know about.
A downloadable PDF with Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage, and pricing data.
Place of Service Codes for Professional Claims: CMS
Download the Medicare Claims Processing Manual Chapter 26: Completing and Processing Form CMS-1500 Data Set.
Next Generation of Coding - ICD-10-CM: Guidelines, Codes, and Descriptions
Details on the diagnosis coding system, ICD-10-CM, developed as a replacement for ICD-9-CM.
National Correct Coding Initiative (NCCI): CMS
Downloadable PDFs explaining how to use the National Correct Coding Initiative tools.
Coverage
Medicare National and Local Coverage Decisions: CMS
Search and view data from the Medicare Coverage Database, which contains all National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), local articles, and proposed NCD decisions.
Reimbursement
Medicare Physician Fee Schedule (Look Up Allowables by State and Code): CMS
Search by type of information, Healthcare Common Procedure Coding System (HCPCS) Criteria, Carrier/Medicare Administrative Contractor (MAC), and more
Medicare Part B Average Sales Price Drug Pricing Files for Physicians
Manufacturer reporting of Average Sales Price (ASP) data and ASP Drug Pricing Files.
Hospital Outpatient Information
Helpful links, resources, and downloads for Hospital Outpatient Prospective System Rulemaking.
Medicare Clinical Lab Fee Schedules: CM
Information on the clinical laboratory fee schedule, regulations, notices, citations, and more.
APPEALS RESOURCES
Find the resources you need to navigate the appeals process
If an insurance claim is denied, the Lilly Oncology Support Center can provide information to help you file an appeal on your patient’s behalf. We’ll help you understand what documents and information you’ll need and the deadlines you’ll have to meet.
If you have questions about filing an appeal, please call us at 1-866-472-8663.
Denied Claims Checklist
If a patient receives a denied explanation of benefits or an unfavorable response to a previous appeal, use this checklist to help you prepare an appeal packet.
Letter of Medical Necessity Information
This guide provides important information needed in your letter of medical necessity to help facilitate the appeal process.
First-Level Appeal Letter for Commercial or Other Insurance
Use this template to create a request letter for a first-level appeal by an oncology medical advisor.
Second-Level Appeal Letter for Commercial or Other Insurance
If your patient’s first appeal was denied or he/she received an unfavorable response, use this letter template to initiate a second-level appeal.
First-Level Medicare Review Letter
If your patient was denied Medicare coverage, this letter template will help you request a redetermination by an oncology medical advisor.
Second-Level Medicare Review Letter
If your patient’s first Medicare review resulted in a denial or an unfavorable response, use this letter template to initiate a second-level review.