What are the hours of operation for BPPS?
Who qualifies for BPPS?
Is BPPS only for low-income or uninsured families?
What if I just want to try KUVAN before going through insurance or BPPS?
How does BPPS help patients who may be worried about their out-of-pocket co-payment or coinsurance for KUVAN?
What can BPPS do to help patients without prescription coverage for KUVAN?
What is prior authorization?
What if my insurance company denies coverage of KUVAN?
How can BPPS help patients who run into problems with their lifetime max running out?
Can BPPS help if a patient’s health insurance coverage changes?
Once I have a case manager, can I communicate with BPPS via e-mail?
What should I do if BPPS contacts me by phone or mail?
How does BPPS keep healthcare professionals updated during the initial referral process?
How does BPPS keep patients updated during the initial referral process?
Do patients and healthcare professionals speak to the same person or to different people when they contact BPPS?
What are the hours of operation for BPPS?
Telephone lines are staffed between 7 AM and 4 PM (PT) Monday through Friday. Calls made after hours are routed to an answering machine where callers can leave a message. All messages are returned within one business day during regular business hours. BPPS can also be reached via fax at
1-888-863-3361. Patients and healthcare professionals can also e-mail BPPS any time at bpps@BMRN.com to arrange for a specific follow-up time.
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Who qualifies for BPPS?
If your doctor and you have decided that you should try KUVAN, you qualify. Because KUVAN is the first prescription medication for the treatment of PKU, getting insurance coverage on your own may be slow or challenging, even with the best insurance plans. BPPS was created to ease the insurance approval process for you, and increase the speed at which it is done.
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Is BPPS only for low-income or uninsured families?
No. BPPS is an integral part of your treatment with KUVAN, regardless of insurance or income status. All patients who have been prescribed KUVAN will need to go through the BPPS process before receiving the medication.
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What if I just want to try KUVAN before going through insurance or BPPS?
Every patient prescribed KUVAN will have to go through BPPS. BioMarin does not provide samples of KUVAN. Because it is not possible to predict whether or not you will respond to the medication until the therapy has been tried for a period of time, you need to secure insurance coverage before starting KUVAN.
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How does BPPS help patients who may be worried about their out-of-pocket co-payment or coinsurance for KUVAN?
BPPS can refer patients to the National Organization for Rare Disorders (NORD), an organization that specializes in this type of assistance for patients with rare diseases. NORD has set up a fund that provides premium and co-payment assistance for patients receiving prescription medication for PKU, as well as other costs directly related to PKU treatment. For an overview of NORD, click here. For more FAQs about NORD, click here.
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What can BPPS do to help patients without prescription coverage for KUVAN?
As a last resort, BPPS can refer patients to the KUVAN Patient Assistance Program (K-PAP), a program that provides KUVAN at no charge for qualified patients without insurance coverage. For an overview of K-PAP, click here. For more FAQs about K-PAP, click here.
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What is prior authorization?
Some insurance companies may need to approve a patient’s treatment with KUVAN before treatment is started. This approval is called "prior authorization." Typically, the insurance company will require the patient’s doctor to provide a Letter of Medical Necessity and/or medical information to the patient’s insurance company that explains why the doctor wants the patient to start this treatment.
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What if my insurance company denies coverage of KUVAN?
If the insurance company denies coverage of KUVAN, denies the doctor’s request for prior authorization, or simply will not cover the cost of the medication, BPPS will work to help the patient and his/her doctor prepare and file an appeal with the insurance company. The appeal will outline why the patient should be receiving KUVAN and how it may benefit the patient. An appeal is used to persuade the insurance company to allow coverage for and access to KUVAN, and to ensure that the insurance company has all the information required. Coverage decisions will vary among insurance companies. If the appeal fails, BPPS will continue to work with the patient to research other options for access to KUVAN.
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How can BPPS help patients who run into problems with their lifetime max running out?
BPPS can help patients using KUVAN research alternative sources of insurance coverage. For additional information, patients can call toll-free:
1-877-MY-KUVAN (1-877-695-8826) or they can e-mail bpps@BMRN.com for information.
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Can BPPS help if a patient’s health insurance coverage changes?
BPPS is available to help KUVAN patients evaluate different insurance options and encourages patients to contact BPPS with questions related to open enrollment, when a child loses coverage from his/her parents’ insurance, or other potential changes in health plan coverage. For additional information, patients can call toll-free 1-877-MY-KUVAN (1-877-695-8826) or they can
e-mail bpps@BMRN.com for information.
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Once I have a case manager, can I communicate with BPPS via
e-mail?
Yes. Each BPPS case manager has a secure, dedicated e-mail address for patients and healthcare professionals to use. BPPS is committed to responding to personal e-mails within one business day of receipt. We encourage individuals with concerns needing more immediate attention to call the KUVAN Hotline at 1-877-MY-KUVAN (1-877-695-8826).
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What should I do if BPPS contacts me by phone or mail?
Please return the phone call or the completed paperwork as soon as possible. There are several steps involved in starting KUVAN therapy, and questions may come up along the way. BPPS stays in touch with patients and healthcare professionals frequently throughout the process to provide status reports, answer questions, and obtain information needed to move to the next step.
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How does BPPS keep patients updated during the initial referral process?
Once BPPS receives the signed Patient Authorization Form, BPPS calls the patient within one business day to provide an introduction to the BPPS case manager and program. After the initial telephone contact, BPPS contacts the patient to discuss the results of benefit investigations for KUVAN, identify plans for addressing additional health plan requirements for coverage, or discuss patient concerns about financial issues associated with therapy. After KUVAN therapy is initiated, BPPS provides updates about the patient’s case as needed.
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How does BPPS keep healthcare professionals updated during the initial referral process?
Once BPPS receives the signed Statement of Medical Necessity/Prescription Form, an acknowledgment fax is sent to the referring healthcare professional the same day it is received. After the referral notification, BPPS sends weekly faxes that outline where the patient is in the reimbursement process, and later list the name and contact number of the specialty pharmacy that is shipping KUVAN to the patient. Patients approved for initial therapy are asked to contact their healthcare professional to discuss the start of treatment. BPPS contacts referring healthcare professionals if any additional assistance is needed (examples: updated medical records, confirmation of prescriptions, or assistance with answering health plan questions).
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Do patients and healthcare professionals speak to the same person or to different people when they contact BPPS?
The goal is to have healthcare professionals and patients associated with a clinic work with the same case manager. All calls to BPPS are routed through a single toll-free number to make sure that they get to the proper person. E-mails go directly to case managers.
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Indication
KUVAN® (sapropterin dihydrochloride) Tablets is approved to reduce blood Phe levels
in patients with hyperphenylalaninemia (HPA) due to tetrahydrobiopterin- (BH4-)
responsive Phenylketonuria (PKU). KUVAN is to be used in conjunction with a Phe-restricted diet.
Important Safety Information
High blood Phe levels are toxic to the brain and can lead to lower intelligence
and decrease in the ability to focus, remember and organize information. Any change
you make to your diet may impact your blood Phe level. Follow your doctor’s instructions
carefully. Your doctor and dietitian will continue to monitor and may adjust your
diet throughout your treatment with KUVAN.
If you have a fever, or if you are sick, your Phe level may go up. Tell your doctor
and dietitian as soon as possible so they can see if they have to adjust your treatment
to help keep your blood Phe levels in the desired range.
KUVAN is a prescription medicine and should not be taken by people who are allergic
to any of its ingredients. Tell your doctor if you have ever had liver or kidney
problems, are nursing or pregnant or may become pregnant, have poor nutrition or
are anorexic. Your doctor will decide if KUVAN is right for you. Tell your doctor
about all the medicines you take.
The most common side effects reported when using KUVAN are headache, diarrhea, abdominal
pain, upper respiratory tract infection (like a cold), throat pain, vomiting, and
nausea.
To report SUSPECTED ADVERSE REACTIONS, contact BioMarin Pharmaceutical Inc. at 1-866-906-6100, or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Please read the full Patient Information by clicking here.