Getting EPIDIOLEX® (cannabidiol) to your patients
You can obtain EPIDIOLEX through two different pathways
Download the JazzCares Start Form
Markella, at age 10
EPIDIOLEX patient living with Dravet syndrome
EPIDIOLEX is available through specialty pharmacies
Use the contact information below to reach any one of the national in-network pharmacies
AcariaHealth
1311 West Sam Houston Parkway N #130
Houston, TX77043
United States
Accredo
1640 Century Center Parkway
Memphis, TN38134
United States
Amber Pharmacy
10004 South 152nd Street
Omaha, NE68138
United States
CVS Specialty
800 Biermann Court
Mount Prospect, IL60056
United States
Kaiser Permanente National Specialty Pharmacy
4131 Geary Blvd. Floor 1, Room 112
San Francisco, CA94118
United States
Lumicera Health Services
310 Integrity Drive
Madison, WI53717
United States
Walgreens Specialty Pharmacy
130 Enterprise Drive
Pittsburgh, PA15275
United States
How to write a prescription
When writing a prescription, ensure you include the titration schedule, weight, and ICD-10 code. As certain health plans and institutions may have policies regarding cannabinoid products/use, prescriptions should include EPIDIOLEX by name to avoid rejection.
TITRATION
Dosing/ titration schedule
Patient weight
ICD-10 diagnosis code
MAINTENANCE
Dosing/ titration schedule
Patient weight
ICD-10 diagnosis code
If dose adjustment is required mid-prescription cycle, a new prescription will be needed.
ICD-10 diagnosis codes
The sample codes provided below are based on publicly available information and are informational only; they are not a guarantee or promise of coverage. Appropriate codes can vary by patient, setting of care, and payer. Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements.
LGS
- G40.811
- G40.812
- G40.813
- G40.814
Dravet syndrome
- G40.833
- G40.834
TSC
- Q85.1
This is provided for example purposes only. Not intended to supersede independent clinical judgment or institutional protocols. Please see full Prescribing Information for recommendations on liver monitoring.
PA support (if required)
Jazz Pharmaceuticals has partnered with CoverMyMeds® to help patients connect with their treatment by:
- Helping to reduce time to therapy with online PA requests
- Receiving faster PA determinations, and often in real time
- Customized appeals support, which includes the appeals letter initiated by their HCP and payer follow-up
- Automatically renewing previously submitted PA requests
To get started:
1
Sign up for a no-cost account, or log in to your existing account at covermymeds.com
2
Initiate or respond to an electronic PA request in the CoverMyMeds® system.
3
Complete requested clinical details and then electronically submit the request to the plan for determination.
Connect with CoverMyMeds® Support from:
Monday-Friday 8 AM–11 PM ET,
Saturday 8 AM–3 PM ET.
CoverMyMeds® Support:
1-866-452-5017
Live chat at
covermymeds.com
Aaron, at age 30
EPIDIOLEX patient living with LGS
Remember to complete the PA form in its entirety
1
Patient demographics and medical history
2
Physician name and NPI number
3
Patient diagnosis (ICD-10 code[s])
4
Product name and dosing
Required information varies by plan; it may help to include rationales, medical records, published data, any pertinent diagnostic or laboratory tests, and all previously tried and failed therapies.
