After you've chosen to prescribe ONPATTRO® (patisiran) for your patient, follow the steps below to help enable patient access, proper claims submission, and reimbursement
1. Together with your patient, complete the Start Form to initiate verification of benefits and an eligibility assessment for patient financial assistance, if required.
2.Schedule the patient's ONPATTRO infusion.
- Before your patient's first infusion, an Alnylam team member will reach out to schedule an on-site ONPATTRO preparation and administration educational in-service
3. Work with Alnylam Assist™ to determine the method for ordering ONPATTRO.
- The Alnylam Assist™ team will help facilitate acquisition of ONPATTRO for your patient via specialty distributor or specialty pharmacy. For some patients, home infusion may also be an option
- Alnylam Assist™ can explain the requirements and processes for prior authorizations, claims, and appeals
- A Field Reimbursement Director can provide education about billing, coding, and the reimbursement process for ONPATTRO
Coverage, coding, and payment
- For patients on Medicare who are receiving ONPATTRO and are covered under Medicare Part B benefit, the Medicare Administrative Contractors (MACs) may require additional
chart documentation to determine the medical necessity of the treatment, although prior authorization is not requireda
- Some payers may also apply utilization restrictions for ONPATTRO
aIt is always 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.
Download the following guides for more information:
Alnylam's Field Reimbursement Directors are available to answer questions you or your staff have about ONPATTRO reimbursement, billing, and coding.