NEXPLANON is covered

NEXPLANON is NOT covered

 
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Medical benefit means that both the drug and procedure are covered under the same benefit.

Pharmacy benefit means that the drug is covered separately from the procedure.

Out-of-pocket costs are all the costs for medical care you have to pay yourself because they are not paid for by your insurance. These costs may be reduced by supplemental insurance or manufacturer co-pay assistance programs.

You may be able to get NEXPLANON for free.

Once you and your health care provider have decided that NEXPLANON is right for you, check with your insurance provider to determine your specific coverage.

You may need to pay a co-pay, deductible, or other charges.

NEXPLANON may be covered as a medical benefit or as a pharmacy benefit. To find out if you have coverage for NEXPLANON as a medical benefit, see the direction below.

The CSCN can help determine your specific coverage for NEXPLANON.  You may also check whether NEXPLANON is covered by following these steps:
Call the customer service number listed on the back of your health insurance card. Be sure to write down the names of any people you speak with.Tell the representative that NEXPLANON is a provider-administered birth control drug (not a device) and that your provider will:• Prescribe NEXPLANON• Order NEXPLANON for you• Insert NEXPLANON during an office visitAsk the representative if NEXPLANON is covered.If the answer is “no,” ask if you have coverage for NEXPLANON as a pharmacy benefit.To get information about your pharmacy benefit, you may have to call another number (such as the pharmacy customer service number on the back of your health insurance card) and speak to a different person.Repeat steps 1–3.
Call the customer service number listed on the back of your health insurance card. Be sure to write down the names of any people you speak with.Tell the representative that NEXPLANON is a provider-administered birth control drug (not a device) and that your provider will:• Prescribe NEXPLANON• Order NEXPLANON for you• Insert NEXPLANON during an office visitAsk the representative if NEXPLANON is covered.If the answer is “no,” ask if you have coverage for NEXPLANON as a pharmacy benefit.To get information about your pharmacy benefit, you may have to call another number (such as the pharmacy customer service number on the back of your health insurance card) and speak to a different person.Repeat steps 1–3.
 
If NEXPLANON is covered:
Ask the person to send verification of coverage to your health care provider, if possible.If written verification cannot be provided, write down the name of the person you spoke with and tell your health care provider what you’ve learned about your coverage from your health plan representative.Ask the representative whether NEXPLANON and the insertion procedure are 100% covered. If not, ask about your out-of-pocket costs. You should also ask your health plan representative about coverage and out-of-pocket costs for removal, keeping in mind your insurance may change.Make an appointment with your health care provider to have NEXPLANON inserted.
Ask the representative whether NEXPLANON and the insertion procedure are 100% covered. If not, ask about your out-of-pocket costs. You should also ask your health plan representative about coverage and out-of-pocket costs for removal, keeping in mind your insurance may change.Ask the person to send verification of coverage to your health care provider, if possible.If written verification cannot be provided, write down the name of the person you spoke with and tell your health care provider what you’ve learned about your coverage from your health plan representative.Make an appointment with your health care provider to have NEXPLANON inserted.

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© 2023 Organon group of companies. All rights reserved. ORGANON and the ORGANON Logo are trademarks of the Organon group of companies. US-XPL-116864 08/23

© 2023 Organon group of companies. All rights reserved. ORGANON and the ORGANON Logo are trademarks of the Organon group of companies. US-XPL-116864 08/23