MySMA Support™ offers a range of access and reimbursement resources for your patients and practice after Evrysdi is prescribed, including help with benefits investigations (BIs), resources for prior authorizations (PAs), sample billing and coding information, resources for denials and appeals, information about distribution and referrals to potential financial assistance options.
Get help understanding insurance benefits and coverage, such as with benefits investigations and prior authorization resources.
MySMA Support™ can conduct a benefits investigation (BI) which can determine:
*If your patient’s request for a prior authorization is not granted, your MySMA Support™ specialist can work with you to determine your next steps.
Get started with enrollment by following the steps below.
If your practice has a registered account for My Patient Solutions, you can get started by logging into your account.
Don't have an account?
Your patient is required to complete the Patient Consent Form. You can either upload their Patient Consent Form as part of your application or have your patient submit the form via fax, text or e-submit.
An online tool to help you enroll patients in MySMA Support™ and manage your service requests at your convenience.
Step 1: Print the Evrysdi Start Form below and have your patient complete the patient consent section of this form.
Step 2: Print and complete the Prescriber Service Form below.
Step 2: Submit the completed forms via fax or text.
Both sections of the form are required. We must have both sections of the completed Evrysdi Start Form before we can help you.
What to expect next:
The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and healthcare provider. Genentech makes no representation or guarantee concerning coverage or reimbursement for any service or item.
Patients facing a coverage delay may be eligible for the Evrysdi Starter Program while awaiting a coverage determination. If you would like your patient considered for the Evrysdi Starter Program, you can indicate this when enrolling in MySMA Support with the Evrysdi Start Form.
Eligible patients can receive up to a ~30-day supply of Evrysdi. If the patient continues to experience a coverage delay, the patient may be eligible for one refill (up to a ~30-day supply) of Evrysdi. Once coverage has been determined, the patient no longer qualifies for the Evrysdi Starter Program.
Subject to eligibility requirements and terms and conditions. This program is void where prohibited by law and may not be used in or by residents of restricted states, if applicable.
The Evrysdi Starter Program (“Program”) provides eligible patients who are experiencing an insurance coverage delay with one free ~30-day supply of Evrysdi. Eligible patients include newborns with an insured parent or an insured legal guardian. Such insured parent or insured legal guardian must attest that the newborn will be added to the insurance policy within the timeframe specified by the insurer. In addition, it must be confirmed that the insurance policy will require prior authorization for Evrysdi. If the patient experiences a persistent coverage delay, the patient may be eligible for one ~30-day refill of Evrysdi. There is no obligation to purchase any future product and receipt of free product is not contingent on any future purchase. Requests for the Evrysdi Starter Program cannot be processed without a completed and signed 1) Evrysdi Prescriber Service Form and 2) Patient Consent Form. Patients must be prescribed Evrysdi for a valid FDA-approved indication.
Neither the prescriber, the pharmacy, nor any patient receiving free medicine via the Evrysdi Starter Program may seek reimbursement or credit for any part of the benefit received by the patient through this offer from any insurer, health plan, or government program.
The Program cannot be counted towards any out-of-pocket costs under any plan (such as true out-of- pocket cost under a Medicare Part D prescription drug plan). The Evrysdi Starter Program Enrollment Team may notify the patient’s insurer that the patient is receiving a free supply of medicine from the Program. Prescribers may not advertise or otherwise use the Program as a means of promoting their services or Genentech’s medicines to patients. This Program is void where prohibited by law and may not be used in or by residents of restricted states, where applicable. The free supply may not be sold, purchased or traded or offered for sale, purchase or trade. This Program is not a benefit plan. Submission of true and accurate information is a requirement for eligibility and Genentech reserves the right to disqualify patients who do not comply from Genentech programs. Genentech reserves the right to rescind, revoke or amend the program without notice at any time.
Sample coding information and resources for denials and appeals
This coding information may assist you as you complete the payer forms for Evrysdi. These tables are provided for informational purposes only. Please visit CMS.gov or other payers’ websites to obtain additional guidance on their processes related to billing and coding.
Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. Genentech does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
If your patient’s health insurance plan has issued a denial, your MySMA Support™ specialist can provide resources as you prepare an appeal submission, as per your patient’s plan requirements.
If a plan issues a denial:
A sample appeal letter and additional considerations are available on the Practice Forms & Documents page.
Appeals cannot be completed or submitted by Genentech on your behalf.
My Patient Solutions is an online tool to help you enroll patients in MySMA Support™ and manage your service requests, all through one portal. It allows you the flexibility to work with MySMA Support™ when it’s convenient for you.
With My Patient Solutions, you can:
How to register
Account registration can be completed by one person for the entire practice and for multiple practice locations. For help with registration or if you have questions, call us at 877-GENENTECH (877-436-3683) (9AM-8PM ET, Monday through Friday).
MySMA Support™ works with specialty pharmacies (SPs) to help patients receive their prescribed Genentech medicines.
In addition to distributing medicines, a specialty pharmacy may provide the following services:
You can work with your preferred specialty pharmacy or contact MySMA Support™ to learn which specialty pharmacy the patient’s health insurance plan mandates or prefers.
A specialty pharmacy (SP)* prepares and ships Evrysdi directly to patients each month. Although the SP is not a part of Genentech, it is an important part of the MySMA Support team.
The SP will call the patient or caregiver to welcome them to the program and to schedule delivery times that work best for them. Remind the patient or caregiver to answer calls from the SP to prevent any delays in treatment.
For a full list of in-network specialty pharmacies, please visit the Genentech Access Solutions website or contact MySMA Support™ at 833-387-9734.
*Specialty pharmacies are not part of Genentech and maintain independence in their operations and in their role as a health care provider.
Genentech does not influence or advocate the use of any one specialty distributor or specialty pharmacy. We make no representation or guarantee of service or coverage of any item. For any product-specific distribution questions, call MySMA Support™ at 833-387-9734 (9AM-8PM ET, Monday through Friday).
We are open from 9AM-8PM ET, Monday through Friday, except for the following holidays:
Evrysdi® (risdiplam) Prescribing Information. Genentech, Inc.
Evrysdi® (risdiplam) Prescribing Information. Genentech, Inc.
Data on file. Genentech USA, Inc.
Data on file. Genentech USA, Inc.
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Darras BT, Boespflug-Tanguy O, Day JW, et al, on behalf of the FIREFISH Working Group. FIREFISH Parts 1 and 2: 24-month safety and efficacy of risdiplam in infants with Type 1 SMA. Poster presented at: Muscular Dystrophy Association Clinical and Scientific Conference; March 13-16, 2022; Nashville, TN.
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