Specialty Pharmacy
In cases where SYNVISC® must be obtained from specialty pharmacies, physicians neither bill nor receive payment for the product; payers reimburse the specialty pharmacies directly. Physicians do bill for professional services related to the administration of SYNVISC.
If you have patients whose insurers require them to order SYNVISC through specialty pharmacies, you may do so using one of these forms. If the form you are looking for is not listed below, please contact the patient's specific insurance company.
- Aetna SP Order Form (PDF, 34K)
- BioScrip Order Form (PDF, 34K)
- Caremark Order Form (PDF, 44K)
- Cigna Order Form (PDF, 56K)
- Curascript Prescription Order Form (PDF, 19K)
- HealthNet Prior Authorization Form (PDF, 37K)
- Humana Caremark Order Form (PDF, 53K)
- IVP Care Pharmacy Services Form (PDF, 43K)
- McKesson Injectable Drug Request Form (PDF, 36K)
- Medco Specialty Pharmacy Form (PDF, 70K)
- Medmark Prescription/Pharmacy Form (PDF, 29K)
- Optionmed Order Form (PDF, 19K) FLA. ONLY
- OptionCare Order Form (PDF ,24K) ALL STATES EXCEPT FLA.
- PharmaCare Order Form (PDF, 21K)
- PharmaCare Rheumatology Referral Form (PDF, 17K)
- Precision Rx Enrollment Form (PDF, 51K)
- Prescription Solutions Authorization Form (PDF, 24K)
- RegenceRx McKesson Order Form (PDF, 47K)
The reimbursement material provided represents the current understanding of Genzyme. Many of the topics covered in this guide are complex and all are subject to change beyond Genzyme's control. Healthcare delivery professionals are responsible for keeping current and complying with reimbursement policy and regulations. This information is not intended to be directive, nor does the use of the recommended codes guarantee reimbursement. Providers should select the codes that most accurately reflect the patient's medical condition, payer requirements, practice patterns, and services rendered. Providers also are responsible for the accuracy of any claims, invoices, and related documentation submitted to payers.
Download more Forms & Sample Letters.