Thyrogen Injections at PDEC

1. Contact the insurance company to determine benefits and coverage

Complete benefit verification and determine if prior authorization is required for CPT code J3240 and what the cost will be for the patient (copay or coinsurance). You will determine if the coverage is by major medical or a pharmacy benefit.

2. If prior authorization is required, send to the auth team to submit

3. If prior authorization is NOT required, contact the patient and ensure they want to proceed

4. If the patient says they would like to proceed, order the medication

5. When the medication arrives, contact the patient to schedule

6. When the patient arrives, ask the patient the following screening questions

- Are you or could you be pregnant?

- Have you had a CT or MRI with "contrast" in the last 3 months?

7. Have the patient sign consent for Thyrogen injection

8. Administer the Thyrogen injection

Consent Form

Thyrogen ONE

If you have commercial insurance, you may be eligible through the Thyrogen Co-Pay Program
To confirm you are eligible, you may call ThyrogenONE at 1-88-THYROGEN (1-888-497-6436). You may download the Thyrogen Co-Pay Self Application Form here
Complete, sign, and fax the Co-Pay Self Application Form. You will be contacted by a ThyrogenONE case manager.
If you qualify, you will receive a Thyrogen Co-Pay Card in the mail. You may use the Thyrogen Co-Pay Card to pay up to $1,000 of your out of pocket expenses.
Already billed for Thyrogen? Call ThyrogenONE to apply for copay assistance.

Patient Financial Assistance Program

With the Thyrogen Patient Assistance Program, eligible* patients may receive Thyrogen free of charge if they:

Medically need Thyrogen, but no longer have insurance.
If their insurance does not cover Thyrogen.
Download and complete the Thyrogen Patient Assistance Program Application Form.