We regularly obtain inquiries about neffy — the needle-free different to epinephrine auto-injectors — chief amongst them issues about insurance coverage protection for the machine.
We lately acquired an replace from ARS Prescribed drugs, the corporate behind neffy, offering the current state of protection by main insurers. Whereas some insurers have been fast to cowl neffy, others are delaying protection and want stress from their constituents earlier than they are going to act.
Right here follows the present state concerning protection and options for these for whom protection is tough or unavailable.
Most well-liked Unrestricted Protection (30% of sufferers)
These insurance coverage firms at present present unrestricted protection for neffy with out prior authorizations and usually with low co-pays. This protection ought to qualify most people for the $25 copay with ARS copay help with a coupon obtainable from www.neffy.com (which is able to hopefully be pre-loaded quickly at CVS pharmacies).
- Specific Scripts
- Cigna Healthcare
- Navitus
- OptumRx (efficient February 13, 2025)
Non-Most well-liked Unrestricted Protection (7% of sufferers)
These insurance coverage firms additionally present unrestricted protection for neffy with out prior authorizations, however they might have increased co-pays. ARS copay help with a coupon from www.neffy.com can probably scale back the affected person’s out-of-pocket bills, however it’s restricted to a $200 low cost (thus, any deductible under $225 would outcome within the affected person paying $25, however increased if deductible is increased that this quantity).
- Medimpact
- New York Staff
- Different smaller insurance coverage firms
Non-Most well-liked with Step Prior Authorization (11% of sufferers)
These insurers cowl neffy however require prior authorization and using an autoinjector earlier than prescription. This observe poses challenges, as new sufferers could also be compelled to make use of a generic autoinjector, disregarding their desire for a needle-free possibility.
- Anthem
- Tricare
- Blue Defend of California (BS of CA)
- Highmark Blue Cross Blue Defend (BCBS BCBS NC)
- A number of different insurers
Not Protecting — Blocked by Insurer (52% of sufferers)
These insurers don’t cowl neffy with out prior authorization. Notably, some insurers require extra vital approval processes as a result of state of affairs and its impression on sufferers and caregivers.
- CVS Caremark
- United Healthcare
- FEP Blue
- Aetna
- Blue Cross Blue Defend of HSCS (BCBS HSCS)
- Blue Cross Blue Defend of Massachusetts (BCBS of MA)
- Prime
- Blue Cross Blue Defend of Michigan (BCBS MI)
- Florida Blue
Necessary notes for these coated by these insurers:
- CVS Caremark (Zinc), the most important pharmacy advantages supervisor in the US, represents 19.5% of the commercially insured. Zinc is anticipated to approve neffy protection by the tip of February. Nevertheless, its inclusion on the CVS Caremark formulary could also be delayed till July 1st as a result of bureaucratic processes with out substantial public stress.
Caremark inserting neffy on its formulary is vital, as that is influential within the approval of neffy protection by Anthem (4.1%) and Aetna (4.1%), each of which use Zinc as a Group Buying Group (GPO).
If Zinc, Anthem, or Aetna govern your protection, you’re urged to contact the insurer and demand that entry to neffy — the one needle-free machine obtainable — is essential to your loved ones’s well-being and ought to be added to its formulary and protection ASAP.
- United Healthcare and OptumRx each use Emisar as their GPO for pharmacy advantages. Though neffy is already on OptumRx’s formulary, United Healthcare has the authority to cowl neffy primarily based on the phrases authorised by Emisar and accepted by OptumRx. However, United has constantly delayed discussions and has been difficult to supply protection to its sufferers even with prior authorization. Thus, United seems to be deliberately making an attempt to delay protection and never pay for this new epinephrine possibility.
If United Healthcare governs your protection, you’re urged to contact the insurer and demand that entry to neffy — the one needle-free machine obtainable — is essential to your loved ones’s well-being and ought to be added to its formulary and protection ASAP.
It’s vital to notice that at this time, the vast majority of commercially insured sufferers encounter protection limitations to acquiring neffy prescribed by their healthcare suppliers. Some insurance coverage suppliers both deny protection or require prior authorization, typically necessitating trial and demonstrating “failure” of “most popular” generic merchandise. Healthcare suppliers have expressed frustration with decoding “failure” when submitting prior authorization paperwork to insurance coverage carriers to acquire neffy as an alternative choice to injection merchandise for his or her sufferers.
Useful info concerning protection for neffy
neffyJoin is their assist program that gives entry assist, monetary help (if eligible), and training for sufferers with a prescription. Get useful assets and instruments delivered to your electronic mail by registering with neffyjoin. neffy can be obtainable by on-line pharmacy BlinkRx, which gives assist with insurance coverage inquiries, finds the very best pricing choices primarily based on eligibility, and affords free at-home supply. BlinkRx additionally sends well timed refill reminders, serving to households keep on prime of their allergy administration.
Retail Pharmacies: neffy is on the market by most retail pharmacies nationwide. As a brand new merchandise, the product is probably not within the pharmacy’s stock every day. Nevertheless, neffy will be positioned by the pharmacist of their wholesaler catalog, then ordered for next-day supply. The pharmacy will usually order neffy when the prescription is adjudicated efficiently and they’re able to dispense.
$25 Co-Pay Program: Eligible sufferers with business insurance coverage could scale back their value to as little as $25 with their co-pay financial savings card. This feature will be discovered within the Financial savings & Help part of www.neffy.com, the place households may obtain the cardboard for simple entry. The co-pay financial savings card shall be mechanically utilized if ordering by BlinkRx.
$199 Money Value: For many who are uninsured, underinsured, or just trying to buy neffy ASAP, BlinkRx and GoodRx supply a money worth of $199 for 2 single-use units.
The ACAAI web site gives a customizable Prior Authorization Letter Generator for neffy to help healthcare suppliers and sufferers in interesting for insurance coverage protection. This instrument permits customers to enter particular particulars similar to affected person info, insurance coverage firm particulars, prescriber info, and analysis codes associated to allergy symptoms or anaphylaxis. As soon as accomplished, customers can obtain a ready-to-use letter template. For households managing extreme allergy symptoms, this letter generator may also help streamline the appeals course of, making it simpler to advocate for vital protection of neffy. Extra info will be discovered on the ACAAI web site.
Steerage for Writing Prescriptions: For physicians who could also be having issue writing prescriptions for neffy, the next info could also be helpful. For added assets, please go to
neffy (epinephrine nasal spray) 2mg/0.1mL
NDC: 82580-0020-02
Dispense as Written
Qty: 2 cartons (4 units)
Affected person Help Program: Their purpose is to supply worry-free assist that ensures everybody can entry neffy at an reasonably priced value. For eligible US residents who’re uninsured or underinsured, meet sure eligibility standards, and have exhausted all different choices, the ARS Prescribed drugs Affected person Help Program (PAP) will present neffy without charge.
Observe of Disclosure: ARS Pharma is an advertiser with SnackSafely.com.
