Frequently Asked Questions

Heron Connect is a suite of programs and services that provide access and reimbursement support related to SUSTOL^® treatment for your practice and financial support for your eligible patients. Heron Connect is staffed by a dedicated team of Reimbursement Counselors who can answer questions and provide support tools. The programs within Heron Connect include:

• Heron Connect Copay Assistance Program*—$0 out-of-pocket costs for SUSTOL for eligible, commercially insured patients. When applicable, patients may also be eligible for deductible assistance up to $200 per treatment
• Heron Connect Patient Assistance Program^†—eligible patients with financial hardship receive SUSTOL at no cost
• Heron Commitment Program^®‡—provides coverage support in the event of a qualifying claim denial, when program requirements are met^§

In addition to these programs within Heron Connect, helpful services for your practice are also provided including assistance with insurance verification, prior authorizations, appeals, billing, coding, and drug replacement.

Any licensed prescriber can sign up patients for Heron Connect programs. Authorized prescribers may vary by state. In addition to medical doctors, prescribers may include physician assistants and nurse practitioners.

Patients can call Heron Connect patient services at 1-844-HERON11 (1-844-437-6611) from 8:30 am to 5 pm ET, Monday through Friday.

Heron Therapeutics, Inc., provides offices with a variety of reimbursement and support services managed through a dedicated Reimbursement Counselor. Services include:

• Patient-specific insurance verification, including eligibility and coverage information such as patient-specific benefits and anticipated out-of-pocket cost sharing responsibility for medical plan coverage based on the patient’s benefit design
• Prior authorization (PA) support, including providing information on the payer’s PA requirements, sending PA forms or template letters of medical necessity to offices, and monitoring the status of requests
• Appeals support, including contacting the payer to understand the payer’s appeal process and providing appeal forms and guidance so that your office can complete the steps necessary to submit an appeal to the payer
• Billing and coding support provided by dedicated Reimbursement Counselors to educate practices on billing, coding, and claims submission inquiries, as well as providing a variety of tools (letters, statements, sample claims forms)

Heron Therapeutics, Inc., offers a Drug Replacement Policy. In the event that SUSTOL is determined to be unfit for patient use, or has expired, Heron Therapeutics, Inc., will replace the affected units. For more information, call Heron Connect at 1-844-HERON11 (1-844-437-6611) from 8:30 am to 5 pm ET, Monday through Friday.^ǁ

Heron Connect can research potential sources of financial support that might be available through independent charitable foundations.

Eligible, commercially insured patients pay $0 in out-of-pocket costs for SUSTOL^® after the deductible is met. When applicable, patients may also be eligible for deductible assistance up to $200 per treatment. No physical copay card is required. Copay reimbursement is offered directly to your practice. Reimbursement Counselors can provide information on financial assistance options and help with copay assistance program enrollment.

Please see the limitations on the Insurance Verification and Program Enrollment Form.

A copay card is not required. Once patients are enrolled in the Heron Connect Copay Assistance Program, they will automatically have benefits for the calendar year.

Patients pay $0 per copay per dose per 12-month calendar period. For this calendar year, the offer expires 12/31/23. For cash-paying patients, the program will cover $150 per prescription up to $1,800 per calendar year. After this time, patients will need to reapply for continued assistance.

To verify benefits and enroll your patients:
Download and complete the Insurance Verification and Program Enrollment Form. Fax form to 1-844-504-8652.

Practices that verify benefits directly can participate in the simplified Copay Assistance Registration:
Enroll your patients online.

OR

First, complete a one-time Practice Copay Assistance Program Enrollment Form. Once the practice enrollment form is complete, individual patients can then be enrolled by completing the Patient Copay Assistance Program Registration Form. Fax forms to 1-844-504-8652.

Patients with financial hardship who meet program eligibility criteria can receive SUSTOL^® at no cost. Reimbursement Counselors can provide information on financial assistance options and eligibility determination, and assist eligible patients with enrollment and coordination to obtain the product at no cost.

Please see the limitations on the Insurance Verification and Program Enrollment Form.

To determine eligibility and enroll patients, you must submit a completed Insurance Verification and Program Enrollment Form and the prescription for SUSTOL by fax to 1-844-504-8652. In most cases, results will be provided within 2 business days. For more information, call Heron at 1-844-HERON11 (1-844-437-6611) from 8:30 am to 5 pm ET, Monday through Friday.

Heron Therapeutics, Inc., is dedicated to ensuring patients and providers have access to SUSTOL^®. In the event of a qualifying claim denial,^§ the Heron Commitment Program will credit your practice for the cost of the administered medication. A qualifying claim denial can be reviewed for the Heron Commitment Program when, for a patient covered under commercial insurance, the following criteria have been met, and documentation confirms: (a) the verification of benefits, conducted by the provider and/or Heron Connect, meets all of the payer criteria and/or policy requirements, (b) the submitted claim for the Heron product is denied, and (c) the claim has been denied again by the commercial payer after the first level of appeals process has been followed.

There is a one-time sign-up for your practice to participate in the Heron Commitment Program. When you complete and submit the Heron Commitment Program Practice Enrollment Form, your practice is entered into the program. All current and future patients are eligible if they meet the requirements. You will only need to provide documentation related to the individual patients.