Infusion financial navigation checklist for expensive medicines

For expensive infused or injected medicines, coverage work often crosses the prescriber, authorization team, specialty pharmacy, infusion center, payer and financial-assistance programs. A simple sequence reduces duplicated work.

A six-step workflow

1. Identify the exact product. Brand, generic, formulation, dose and intended site.
2. Identify the benefit. Medical benefit, pharmacy benefit or plan-specific specialty pathway.
3. Open the controlling source. Current payer policy, Medicare rule, Medicaid/MCO policy or plan criteria.
4. Verify product and code identity. Preferred product, HCPCS/J-code, units, NDC and site-of-care/supply rules as applicable.
5. Resolve the remaining patient cost. Manufacturer support, independent foundations and treatment-site financial assistance.
6. Hand the patient a public path. Print/share the medicine guide or Coverage Action Plan without sending patient data to MedicineCostHelp.

When something changes

Use the “Report outdated info” link on a medicine guide. Send the page and the official source that changed — not the patient’s chart, claim or identifiers.