Adbry Bridge Care Program

Funded
About
The Adbry Bridge Care Program provides essential support for patients utilizing the drug Adbry. Eligible patients, who may experience delays or denials in insurance coverage, can receive Adbry for up to six months while seeking insurance approval. This program is especially beneficial for those with private insurance but without existing coverage for Adbry, enhancing access to this important medication.
Insurance requirements: Commercially insured, Underinsured
Enrollment Forms
Enrollment Form
Program Requirements
•Valid only for residents in the US and Puerto Rico
•Must be 18 years of age or older
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: No
•Activation Required: No
Program Details
•Eligible, commercially insured patients whose insurance does not yet cover Adbry® provides for a maximum of six (6) months of shipment of Product, on a periodic basis, within a twentyfour (24) month consecutive time period commencing on the initial date of dispense for such patient’s lifetime, or until such patient receives insurance coverage approval, whichever occurs earlier
•On a regular basis, Adbry Advocate will verify whether the patient has secured a coverage determination or, if a noncoverage determination has been issued, whether the patient has submitted an appeal
•Patient must experience either:
•1. A delay of more than seven (7) days in securing an insurance coverage determination (i.e. the actual submission of a request for coverage determination, such as a prior authorization request) either at therapy initiation or in connection with a change in insurance provider or coverage (e.g., due to a change in employment); or
•2. A denial of insurance coverage based on a prior authorization request – either at therapy initiation or in connection with a change in insurance provider or coverage (e.g., due to a change in employment) – for which an appeal of the coverage denial, on behalf of the patient, has been submitted or will be submitted within thirty (30) days of such denial
•HCP should fax completed Enrollment and Prescription Form to: 8554230011
•HCP may also complete the digital enrollment form or submit an eRx at https://adbryerx.com/#/
•Call 8446923279, MondayFriday, 8AM8PM ET, for assistance or additional information