Claims Appeals banner - coverage Access support

Coverage & Access Support

The instructions below will help you get started. Click the “Forms & Resources” tab above to find more forms and information.

Logo for Injectafer(R) (ferric carboxymaltose injection)

Injectafer coverage access tabs

Insurance Verifications

Specialists are available to help verify payer coverage and reimbursement policies for Injectafer.

Benefits verifications

Prior authorizations

Claims appeals

Fill out the Patient Enrollment Form, check off the support you require for your patient, and fax it to 1-833-471-9988.

Download in English Download in Spanish

If you have questions about Injectafer support, call: 1-866-4-DSI-NOW (1-866-437-4669). To download a sample letter of medical necessity, click here.

The completion and submission of coverage- or reimbursement-related documentation are the responsibility of the patient and healthcare provider. Daiichi Sankyo, Inc., makes no representation or guarantee concerning coverage or reimbursement for any service or item. A completed form includes signatures from both the physician and the patient. Before submitting, please ensure all required information is provided.