Information on Insurance Coverage for ure-Naure-Na billing code (used in place of an NDC): 62530-0000-11
Insurance may offer coverage for ure-Na under Prior Authorization. The Prior Authorization form specific to the insurance plan will have to be submitted to the insurer requesting coverage. To find the correct form, a simple internet search can be done, most Prior Authorization forms can be found and submitted at covermymeds.com (providers and pharmacists section) or the patient's pharmacy may be able to access the correct Prior Authorization form.
Ure-Na is getting covered. Sometimes it is covered after the initial Prior Authorization and sometimes upon appeal if the initial Prior Authorization is denied.*
For patients with VA benefits, ure-Na is on the VANF (VA National Formulary). Ure-Na is listed as: UREA 15GM/PKT/PWDR,ORAL.
Medicare Part D is prescription drug coverage for Medicare enrollees. After a Prior Authorization is submitted to a Medicare Part D provider (sometimes called sponsor), coverage for ure-Na may be denied stating that the Medicare Part D Act does not allow coverage of OTC (Over The Counter) products. This is partially true in that the Act is for coverage of prescription drug products and it specifically denies coverage for OTC products under the the prescription drug benefit.
The Act was revised to allow coverage of OTCs via the Insurers Administrative costs structure.
Chapter 6 Section 10.10 of the Medicare Prescription Drug Benefit Manual specifically states:
10.10 - Over-the-Counter Products (OTCs)
(Rev. 2, Issued: 07-18-08; Effective/Implementation Date: 07-18-08)
The definition of a Part D drug does not include OTCs. Therefore, Part D sponsors cannot cover OTCs under their basic prescription drug benefit or as a supplemental benefit under enhanced alternative coverage. However, CMS will allow Part D sponsors the option to provide OTCs as part of their administrative costs structure. Refer to chapter 7, section 60, of this manual for further discussion of this option.
If coverage from the Prior Authorization is denied, there is often times an appeal option. Typically the Insurer or Medicare Part D Sponsor sends a letter to the covered patient and sometimes to the Health Care Provider as well as to why it was denied and what appeal options are available.
If coverage is denied because OTCs are not covered under the
Prescription Drug Benefit, requesting coverage under the plans administrative cost structure may be an option.
More information can be found on this subject at the Medicare (CMS) website by clicking here.
For more information or help with reimbursement, please call
1-844-980-9933 and leave a message to be called back by a reimbursement specialist.
*While ure-Na is being covered by some insurance carriers/sponsors, there will likely be some who opt not to offer coverage.