Quick guide

Verify each woman's benefit plan

Insurance coverage varies from patient to patient — it is important to know what coverage the patient has before NEXPLANON is purchased.

• Provide all relevant patient information.
• Request coverage status for both product and procedure. You may be asked for additional details, including appropriate codes and product-related information.
• Obtain an Explanation of Benefits from the plan's representative.

Understand the Explanation of Benefits:
When covered, NEXPLANON is most commonly covered as a medical benefit. This means that both the drug and procedure are covered under the same benefit. Less commonly, NEXPLANON is covered as a pharmacy benefit. This means that the drug is covered separately from the procedure.

If NEXPLANON is not covered:
The patient can contact a human resources manager or health plan representative to determine if a medical exception can be authorized. Your patient has the option to pay for NEXPLANON with cash or a credit card.

The specialty distributor's customer service department will contact you within 48 hours after you submit a form.

Call 1.877.467.5266 with any questions.

The reimbursement-related information provided herein is general in nature and is subject to change at any time. It is supplied for informational purposes only and is not intended to be conclusive or exhaustive, does not constitute legal advice, and is not intended to replace the guidance of a qualified professional advisor. You should check with the applicable payer for payer-specific guidelines. As a provider, you are solely responsible for correctly billing payers, including selecting codes that most appropriately reflect the services rendered and the applicable payer’s guidelines. Merck makes no representation or guarantee as to the accuracy, timeliness or appropriateness of this information for your particular purpose. Use of this information does not guarantee coverage or payment of any specific reimbursement level.