Comprehensive Benefit Investigation

Before your first dose, our dedicated insurance specialists perform a thorough review of your pharmacy and medical benefits. We identify exactly how your plan covers your specific therapy, so there are no surprises at the pharmacy counter.

Coordination of Benefits: We manage the complexities of primary and secondary insurance to ensure claims are processed accurately.

Real-Time Adjudication: We provide immediate clarity on co-pays and coverage tiers.

Expert Prior Authorization (PA) Management

Specialty medications often require clinical justification before an insurer will provide coverage. We take the lead on the paperwork, working directly with your physician’s office to secure approvals quickly.

Clinical Documentation: We assist in gathering the necessary medical records to support your claim.

Appeals Support: If a claim is denied, our clinical team works to file comprehensive appeals to advocate for your necessary treatment.

Proactive Financial Assistance & Grants

We believe that no patient should have to choose between their health and their finances. Our team proactively searches for external funding sources to bridge the gap in coverage.

Co-pay Assistance Programs: We enroll eligible patients in manufacturer-sponsored programs that can reduce co-pays to as little as $0.

Foundation & Grant Coordination: For patients with high deductibles or those in the “donut hole,” we identify and apply for independent charitable grants.

Patient Assistance Programs (PAP): We help uninsured or underinsured patients access medications through specialized industry programs.

Medicare & Medicaid Navigation

Government-sponsored plans come with unique regulations and “stages” of coverage. Our team helps you understand how your Medicare Part D or Medicaid benefits apply to specialty drugs, helping you plan for costs throughout the calendar year.

The Hillside Commitment to Access

“Our goal is simple: To ensure that every patient who needs a specialty therapy can afford to start it and stay on it. We handle the insurance complexities so you can focus on your recovery.”