Insurance Coverage for ure-Na


For help with reimbursement please call 1-844-980-9933 and leave a message to be called back by a reimbursement specialist.

The NDC code for ure-Na for Insurance Prior Authorization is 62530-0000-11


Insurance may offer coverage for ure-Na under different insurance policy benefits depending on what type of policy you are requesting coverage under. Please see potential coverage options below.



Medicare Advantage
Medicare Advantage plans offer expanded coverage in 2019 for OTC items like ure-Na. Coverage may be obtained from the Primary Health Related Supplemental Benefit. You will have to contact your Medicare Advantage plan and ask what the coverage process is for OTCs under the Primary Health Related Supplemental Benefit.

To gain coverage from the Primary Health Related Supplemental Benefit, ure-Na has to be recommended by a qualified Health Care Provider.

You may also gain coverage for ure-Na from your Medicare Advantage plan under a general supplemental benefit.

You may also gain coverage for ure-Na under your pharmacy benefit.

To gain coverage for ure-Na under any of these avenues, you will need to contact your insurance carrier and ask how authorization is gained. Often times there is a form that has to be filled out and signed by the doctor who is recommending ure-Na. Your insurance carrier may require that the Doctor recommending ure-Na document that it is Medically Necessary.

If you reach out to your insurance carrier and you speak with an agent and they state that ure-Na is not covered, ask them how to request coverage and a medical review of your request for coverage.

Many Insurance Carriers have a process to review and authorize coverage for products like ure-Na.


VA Benefit
Ure-Na is on the VA National Formulary (VANF) listed as: UREA15GM/PKT/PWDR,ORAL.

If you are currently receiving pharmacy benefit from the VA, ure-Na is available as the above listed item.

If you qualify for VA benefit, but you are not currently receiving benefit, please contact your local VA for more information on how to receive VA medical and outpatient pharmacy benefit.



Medicaid or Medicare/Medicaid Dual Eligible
Ure-Na may be covered under your State Medicaid plan or under your Medicare Part D plan if you are also medicaid eligible. Medicaid may offer coverage under your prescription benefit for the coverage of OTCs or under your medical benefit. Medicare Part D may offer reimbursement of OTCs under your prescription drug benefit.

Please contact your State Medicaid plan or your Medicare Part D plan for coverage options. To be qualified for coverage, ure-Na has to be recommended by a qualified Health Care Provider. Sometimes ure-Na may be covered after an initial Prior Authorization and sometimes upon appeal if the initial Prior Authorization is denied.



Commercial Insurance
Commercial Insurance is coverage from your employer or from the ACA (Obama Care). Reimbursement coverage for ure-Na may be obtained under a supplemental benefit for OTC items from your medical benefit or from your pharmacy benefit if your plan offers coverage for OTCs.

For coverage, ure-Na has to be recommended by a qualified Health Care Provider.

You will need to reach out to your insurance and ask about coverage options of OTCs as most plans are different.



Medicare Part D
Medicare Part D is prescription drug coverage for Medicare enrollees. Reimbursement coverage may be obtained from your prescription benefit when 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 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.

However.

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 help with reimbursement, please call
1-844-980-9933 and leave a message to be called back by a reimbursement specialist.