How is SANTYL Ointment most commonly reimbursed?
As a service to you and your patients, we have collected a number of reimbursement possibilities for you to consider.
Hospital Outpatient Department (HOPD)/Qualified Healthcare Professional Office (QHP)†
Most commonly, a patient would be given a prescription and would obtain SANTYL Ointment from a retail pharmacy and the patient’s prescription drug benefit would cover and pay for the drug (eg, through commercial insurance, Medicare Part D, or Medicaid).
If the HOPD or QHP provides and uses SANTYL Ointment on the patient during his or her visit, the HOPD or QHP is responsible for the cost of the drug.
Hospital†
Most commonly, the cost of SANTYL Ointment is included in a lump sum payment to the facility from a payer in the form of a Diagnosis Related Group (DRG) or per diem. If, however, the facility is paid based on charges for a patient, SANTYL Ointment may be separately billable.
Home Health Care†
Most commonly, a patient would be given a prescription and would obtain SANTYL Ointment from a retail pharmacy and the patient’s prescription drug benefit would cover and pay for the drug (eg, through commercial insurance, Medicare Part D, or Medicaid).
Nursing Home†
NON-SKILLED: Most commonly, the cost of SANTYL Ointment is covered under the patient’s prescription drug benefit (eg, commercial insurance, Medicare Part D, or Medicaid).
SKILLED: Most commonly, the cost of drugs are covered in a lump sum per diem payment (eg, Resource Utilization Group (RUG) for Medicare or through Medicaid formulary).
Help for low-income patients
What is the Patient Assistance Program (PAP)?
The Smith+Nephew Patient Assistance Program (PAP) provides prescription drugs at no cost to eligible patients who are low-income and uninsured or underinsured. With our dedicated team to handle the PAP, healthcare professionals can focus on prescribing medications to patients without regard for their ability to pay.
PAP eligibility requirements
- Must be a U.S. resident (includes Puerto Rico)
- Patient must be uninsured (no insurance) or underinsured (no coverage)
- Patient must meet financial requirements to qualify for Medicaid or have Medicaid coverage where the product is not covered
- Patient must be under the care of a licensed medical professional and have a prescription for SANTYL◊ Ointment
- Low-income patients 65 and above are covered by Medicare Part D and are thus not eligible for this program
How can I enroll my patients?
- A Smith+Nephew Patient Assistance Program application can be initiated by anyone, including but not limited to a primary care physician, traveling physician group, case manager, social worker, patient or patient caregiver.
- For the PAP application to be processed quickly, each application should include complete and accurate information of the patient and the prescriber, as well as a prescription.
- The application must include both the prescriber’s and the patient’s (or authorized representative's) signatures. Applicants will only be evaluated for eligibility upon receipt of a completed and signed Smith+Nephew Patient Assistance Program application.
- Our dedicated team will inform the healthcare professional when the PAP application is approved or denied or if additional information is needed.
- When approved, the product will be sent directly to the patient via FedEx 2Day®. Packages are delivered within two business days throughout the United States.
Where do I start?
- Download a copy of the application here
- After completing and signing (both prescriber’s and patient’s signatures required) you can fax the application to 833-965-1621 or email it to: patientassistanceprogram.us@pap.smith-nephew.com.
Reimbursement demystified
Private Office/Wound Care Center/Home Health
For additional information on what patients pay for SANTYL Ointment, please click here.
SANTYL Ointment also offers a copay assistance program. Your patients could save up to $250*. Click here to learn more.
Hospital/Inpatient
During the inpatient stay, all prescription drug costs are included in the Diagnosis Related Groups (DRG) payment. There can be a copay or coinsurance while in the hospital, but there is no separate copay for pharmaceuticals used during a hospital stay. Upon discharge, any medication prescriptions would be treated as a Retail prescription.
Long Term Care
Long term care can be confusing for patients. SANTYL Ointment has partnered with CoverMyMeds to help with this transition. Learn more here.
For more information, please call the hotline at 1-800-364-4767.
Download additional information on what patients pay for SANTYL Ointment.
SANTYL Ointment also offers a copay assistance program. Your patients could save up to $250*.
We understand that some insurances require prior authorizations for SANTYL Ointment.
Download a template to help with this requirement.
Completing a Pharmacy-Initiated PA Request
More than 96 percent of pharmacies nationwide use CoverMyMeds to start a prior authorization (PA) request to send to a provider.
Here’s what providers need to know.
Reimbursement in long term care differs based upon the level and duration of care, as well as the payer(s) applicable to each patient.
For additional information on retail pharmacies click
† Information on reimbursement in the United States is provided as a courtesy. Due to the rapidly changing nature of the law and Medicare payment policy and the reliance on information provided by outside sources, the information provided herein does not constitute a guarantee or warranty that reimbursement will be received or that the codes identified herein are or will remain applicable.
This information is provided "AS IS" and without any other warranty or guarantee, expressed or implied, as to completeness or accuracy, or otherwise. This information has been compiled based on data gathered from many primary and secondary sources, including the American Medical Association and certain Medicare contractors.
Physicians and other providers must confirm or clarify coding and coverage from their respective payers, as each payer may have differing formal or informal coding and coverage policies or decisions. Physicians and providers are responsible for accurate documentation of patient conditions and for reporting of procedures and products in accordance with particular payer requirements.
The reimbursement information in this section was last verified December 2023.
*Not valid for prescriptions eligible to be reimbursed under Medicare (including Medicare Part D and Medicare Advantage), Medicaid, TRICARE, CHAMPUS, The Puerto Rico Government Health Insurance Plan, or other federal, state, or government healthcare programs. Valid in the US only, void where taxed, restricted, or prohibited by law. Accepted by participating pharmacies only. This Copay Assistance Program is not insurance and may be changed or discontinued at any time without notice.