Enroll Your Patient
Enrolling your patient in ADVANCING Patient Support is easy. You can either complete and submit the enrollment form online, or you can download the form here and submit via fax or email.
Overview of Services
ADVANCING Patient Support offers the following services to assist patients during the treatment process:
Benefits investigation—enrollment initiates a benefits investigation:
A summary of benefits will be provided to help you and your patient better understand their insurance coverage and out-of-pocket costs.
Helps determine if a prior authorization or precertification is needed for your patient and can provide guidance and support throughout the process.
Provides guidance on coding and billing, the appeals process, and can help answer any questions that may arise.
Commercial copay program:
If eligible, your commercially insured patient can be enrolled in the copay program. Your patient may pay as little as $0 per dose.a
Patient Assistance Program:
Your patients who are uninsured or underinsured could receive ZYNLONTA® for free if they meet the criteria for the Patient Assistance Program (PAP).
Our dedicated nurses can answer questions about the medication, help patients plan conversations with healthcare providers, and connect patients to other available services and support.
a For commercially insured patients, 18 years of age and older with coverage for ZYNLONTA®. Patients are not eligible if they participate in any federal or state healthcare program with prescription drug coverage, such as Medicaid, Medicare, Medicare Part D or Medicare Advantage plan, VA, DOD or TRICARE. Excludes patients who are uninsured or full cash-paying. Maximum benefit per patient, per calendar year (1/1-12/31) is $25,000. Additional eligibility requirements and other restrictions apply. Visit ADVANCINGPatientSupport.com/copay-terms-conditions
Frequently Asked Questions
ADVANCING Patient Support is a patient support program from ADC Therapeutics. The program offers personalized assistance for patients being treated with ZYNLONTA®, including assignment of a dedicated case manager, coverage and financial support, as well as nursing support for patients.
For more information, call 1-855-690-0340 to speak with a case manager. (Case managers are available Monday-Friday, 8 AM – 8 PM ET.)
ADVANCING Patient Support offers personalized assistance for patients being treated with ZYNLONTA®.
Once you send in the completed enrollment form, a benefits investigation is initiated.
Within 24-48 hours, your office will receive next steps related to the benefits investigation. Keep in mind a prior authorization and/or appeal may be needed. Be sure to fill in all
patient information and signatures on the ADVANCING Patient Support enrollment form to minimize delays.
Unfortunately, ADVANCING Patient Support cannot fill out or send prior authorization paperwork or draft letters (eg, letters of medical necessity) for you. ADVANCING Patient Support provides example letters you can refer to in preparing your responses to the patient's health plan.
Often with new products, prior to medical policy development, you may encounter terms such as “non-formulary product,” “NDC blocked,” or “medical exception.” Each of these can typically be approached through the medical exceptions process, which is often handled similarly to how a prior authorization is handled, and is specific to a given payer. Specific process information can typically be found online or through the payer’s provider relations department.
For more information or support, contact ADVANCING Patient Support at 1-855-690-0340.
After the benefits investigation is completed, ADVANCING Patient Support will assess your patient for the commercial copay and patient assistance programs, if requested. You will receive a fax to let you know the status of your patient’s eligibility.
Be sure to complete all aspects of the enrollment form (including signatures) to avoid delays.
ADVANCING Patient Support can help answer your coding and billing questions related to ZYNLONTA®. It's important to consider the following:
- Understand coding/billing requirements on a payer-specific basis
- Use the J-code for ZYNLONTA® for dates of service on or after April 1, 2022: J9359 (Injection, loncastuximab tesirine-lpyl, 0.075 mg)
- Respond quickly to any documentation requests
- Keep copies of all submitted claims
- Electronic submission can improve payment turnaround time and reduce errors
- Coverage denials can be common with new products
- Oftentimes, denials may result from minor errors, such as improper coding—plans may simply need additional information
- A rejection, on the other hand, needs to be corrected and resubmitted
- Be sure to check with the patient's health plan to understand their requirements and timelines
- Either way, ADVANCING Patient Support can help you throughout the process
Download the Coding/Billing Guide for general reference information.
Information provided by ADVANCING Patient Support is not a guarantee of coverage or reimbursement for any product or service.
Yes, ADVANCING Patient Support can help find out why your claim was denied by the health plan and help you identify what information may be needed as you prepare the appeal. Once your appeal is filed, we can follow up with the health plan on your behalf until a coverage decision is made.
There are two ways to submit a copay claim:
Electronically, with an ANSI X12 837 request for payment. The provider can use their own billing system to submit using the ADVANCING Patient Support information:
Payer ID: 56155
Member ID: (9 characters, unique to each patient)
Mail or Fax:
ADVANCING Patient Support Copay Program
2250 Perimeter Park Drive, Suite 300
Morrisville, NC 27560
Toll-free Fax: 1-855-915-3005
The ADVANCING Patient Support Copay Program is acting as a secondary payer. If the claim is submitted electronically, the Coordination of Benefits (COB) Payer Amounts will need to be entered for ZYNLONTA®.
If the claim is a manual submission (via fax or mail), please include a secondary claim form (CMS-1500, UB-04, etc) plus the primary Explanation of Payment (EOP) or Remittance Advice (RA).
Claim and supporting documents should include line-level detail so that the patient responsibility for ZYNLONTA® after primary is clear. Details should include the following:
- HCPCS and NDC
- HCPCS and product name
Claims with missing documents or insufficient detail may be denied or misrouted.