Access and reimbursement support program
Designed to help you and your patients understand and gain access to coverage and reimbursement for YUTIQ. Call 1-833-EyePoint (1-833-393-7646) for assistance.
Submit a patient through the EyePoint Assist HCP Portal
The EyePoint Assist HCP Portal allows you to submit patients for a benefits investigation, confirm insurance eligibility, and gain access to financial and reimbursement support.
To learn more, call 1-833-EyePoint (1-833-393-7646) for assistance.
New users: register for the portal
Download this onboarding form to sign up today.
Registered users: sign in to the portal
This link takes you directly to the EyePoint Assist HCP Portal.
Enroll a patient in EyePoint Assist
Download this form. Once completed, fax to 1-866-783-3124.
Key services include:
- Coverage verification
- Prior authorization assistance
- Benefit status update
- Appeals support
- Billing and coding information
- Specialty pharmacy prescription support
- Coordinate health insurance coverage
- Determine associated out-of-pocket costs
- Determine eligibility for the co-pay program or Patient Assistance Program (PAP)
- Reliance Program Support
For Medicare reimbursement rate for YUTIQ, visit CMS.gov
Refer to these sample forms for guidance on how to properly fill out a CMS-1500 or UB-04 form
Permanent J code: J7314
Scroll Table
| Code Type | Code | Descriptor |
|---|---|---|
| HCPCS | J7314 | Injection, fluocinolone acetonide, intravitreal implant (YUTIQ), 0.01 mg |
| 10-digit NDC 11-digit NDC | 71879-136-01 71879-0136-01 | YUTIQ (fluocinolone acetonide intravitreal implant) 0.18 mg |
| WAC pricing |
|---|
| Current WAC $8,996 |
Ordering YUTIQ
YUTIQ is available through these specialty distributors.
Scroll Table
| Specialty distributor | Phone number | Fax number | Item order number |
|---|---|---|---|
| Besse | 1-513-851-2345 | 1-513-851-3299 | 53837 |
| Metro Medical | 1-800-768-2002 | N/A | 718790 |
| McKesson Specialty Health | 1-855-477-9800 | 1-800-800-5673 | 5008760 |
| McKesson Plasma & Biologics | 1-877-625-2566 | 1-888-752-7626 | 3750148 |
| FFF Enterprises | 1-800-843-7477 | 1-800-418-4333 | YUT013601 |
YUTIQ is also available for consignment through FFF Enterprises.
Scroll Table
| Specialty distributor | Phone number | Fax number | Item order number |
|---|---|---|---|
| FFF Enterprises | 1-800-843-7477 | 1-800-418-4333 | YUT013601 |
Learn more about the YUTIQ consignment program through FFF enterprises.
Download the YUTIQ ordering and reimbursement process guide
Learn more about the ordering process for your office.
YUTIQ in practice: a CEO's perspective
Jeff Brockette, CEO, Texas Retina Associates
Listen to the CEO of Texas Retina Specialists discuss EyePoint support, getting started with YUTIQ, and HUB enrollment.
Downloadable resources
EyePoint Assist Reimbursement Support Forms
YUTIQ Reimbursement and Diagnosis Codes
An at-a-glance guide designed to provide important codes to properly bill for YUTIQ.
YUTIQ Ordering and Reimbursement Process
An overview of the step-by-step ordering and buy-and-bill reimbursement process for YUTIQ.
HCP Portal Registration Form
HCP Portal Registration Form to gain access to online case submission, tracking, and reimbursement support.
CMS 1500 submission form
Example of the CMS 1500 form used by physician offices for Medicare and some commercial payer billing.
UB-04 submission form
Example of the UB-04/CMS 1450 form used by hospital outpatient departments for Medicare and some commercial payer billing.
EyePoint Assist Patient Enrollment Form
A key component to getting patients started on YUTIQ and enrolled in financial support offerings such as co-pay support.
Medical Necessity Form
This letter provides an example of the types of information that may be provided when responding to a request from a patient’s health plan to provide a letter of medical necessity for treatment with YUTIQ.
Claim Appeals Form
This letter provides an example of the types of information that may be provided when appealing a claims denial from a patient’s health plan for treatment with YUTIQ.
CMS=Centers for Medicare & Medicaid Services.
