Novartis Patient Support™
Coverage and Affordability
PLUVICTO is accessible for most insured patients*
>80% of insured patients have favorable coverage for PLUVICTO as of January 20251
The other 20% do not have published policies and/or cases may be decided on an individual basis. Follow up with the patient’s plan to determine coverage.
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.
Coverage determined based on patients treated with at least one ARPI and one taxane.
PATIENT ACCESS LOOKUP TOOL
A resource to help you understand patient coverage for PLUVICTO by state, payer, and plan type†
View insurance coverage for PLUVICTO
Download prior authorization forms and coverage summaries for PLUVICTO
Obtain payer contact information
*The information provided in this communication is not a guarantee of coverage and patient OOP costs may vary. Actual coverage and reimbursement decisions are made by individual payers following the receipt of claims and will vary.
†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
A DEDICATED TEAM FOR YOU AND YOUR PATIENTS
Novartis Patient Support is a comprehensive program that is designed to help your patients start, stay, and save on PLUVICTO
Your practice and patients will have access to a Novartis Patient Support team committed to supporting your patients, including:
Dedicated assistance with access and reimbursement
Personalized support for your patients on therapy
Single points of contact for you and your patients
As you consider your patient’s next step, is it time to consider PLUVICTO?
Insurance Support
Help navigating the insurance process, including benefits verification and support with the prior authorization and appeals processes
Benefits Verification
Once you’ve enrolled your patients in Novartis Patient Support, our team will conduct a benefits verification to better understand your patient’s coverage, including:
Informing your practice about additional requirements, such as prior authorization
Identifying savings options available to your patients
Prior Authorizations (PAs) and Appeals
Novartis Patient Support can help with PA requests or letters of appeal by working directly with you or your office, including:
Providing helpful information and timely updates via phone
Financial Support
Assist with connecting patients to relevant saving options.
At Novartis Patient Support, we understand that affordability is important. That’s why we offer a range of savings options and resources to help your patients access treatment regardless of their ability to pay.
Co-Pay Plus
To sign up for the $0 Co-Pay Plus offer:
Providers, with their patients, can complete the PLUVICTO Start Form and send to Novartis Patient Support.
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.
Getting Patients Started with Novartis Patient Support
Download the Start Form
Complete the Start Form, capture consent, and submit
- Fill out all required sections with the patient. Ensure both you and the patient sign to capture consent
- Fax completed form to Novartis Patient Support at 844-638-7329. Missing information may result in delays. Novartis Patient Support will contact you to request any incomplete information
Connect with Us
A dedicated Novartis Patient Support team is available to work alongside you and your patients every step of the way. Call us at 844-638-7222.
Coding & Billing Support
Novartis Patient Support is dedicated to helping you get treatment for your patients.
Ongoing Support
Novartis Patient Support provides patients with ongoing help to stay on track with their PLUVICTO treatment plan, including:
A dedicated Novartis Patient Support Team member to answer their questions at every step
Information on financial support options
How to prepare for treatment
What to expect after treatment
What the most common side effects with treatment are
Their choice of calls and emails
Novartis Patient Support does not provide clinical advice or care and is not a substitute for patient consultation with a health care provider.
Product Ordering
PLUVICTO can be delivered within 5 days of order placement,* so your patients can begin treatment as soon as possible3
With unconstrained supply, we've increased production for faster, on-time delivery of PLUVICTO to meet current and future demand
~99% on-time delivery for all PLUVICTO orders4
~66K doses shipped from launch to date5,†
Ready to order PLUVICTO for your patient? Our team is available to assist you every step of the way.
†US commercial orders only.
Resources
Novartis Patient Support has helpful resources for you and your practice to help support your patients throughout their treatment journey.
Start Form
Coding & Billing Guide
PLUVICTO Co-Pay Reimbursement Form for HCPs
PLUVICTO Co-Pay Reimbursement Form for Patients
PLUVICTO Sample Letter of Appeal
PLUVICTO Reimbursement Guide
LOCAMETZ Reimbursement Guide
Novartis Patient Support Overview for HCPs
PLUVICTO at a Glance
LOCAMETZ at a Glance
Questions?
Novartis Patient Support and a dedicated Novartis Patient Support team are available to work alongside you and your patients every step of the way. Call us at 844-638-7222 ↗, Monday-Friday, 8:00 AM-8:00 PM ET, excluding holidays.