2 ways to prescribe Vyleesi
by choosing an exclusive specialty pharmacy in your EHR system:
Download and fax
the Rx form, prescription, and patient insurance card to the specialty pharmacy listed on the form
Download Rx form
The code for HSDD: F52.0
HSDD is miscoded over one-third of the time. Vyleesi may have a prior authorization with some payors. If you have diagnosed your patient with HSDD, the proper diagnosis code in ICD-10-CM is F52.0. The code for HSDD in ICD-11 is HA00.2.1-3*
HSDD=hypoactive sexual desire disorder.
EHR=electronic health record; ICD-10-CM=International Statistical Classification of Disease and Related Health Problems, Tenth Revision, Clinical Modification; ICD-11=International Statistical Classification of Disease and Related Health Problems, Eleventh Revision.
*Any decision regarding specific coding is at the discretion of the HCP. Provision of this information does not guarantee reimbursement.
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Most eligible patients will pay $0 for their Vyleesi prescription.*
Each Vyleesi prescription includes 4 autoinjectors. Patients with eligible commercial insurance may receive their prescription of Vyleesi for free. Patients with commercial insurance not covering Vyleesi, or patients without insurance, can still receive Vyleesi at a discounted cash price.
*Depending on insurance coverage, most eligible patients may pay as little as $0. Each patient’s eligibility is evaluated on an individual basis. Patients must be 18 or older to qualify. These programs and any assistance provided may be discontinued or modified at any time based on eligibility, state and local laws, and program availability. Patients insured by a government-funded program (Medicaid, TRICARE, etc.) are not eligible.
Financial assistance applies to the patient’s copay, coinsurance, or deductible for patients receiving Vyleesi. Palatin contributions against patient deductible and/or out-of-pocket maximums are subject to possible health plan restrictions. Palatin copay assistance will only apply to 2 fills every 30 days. Enrollment into the program cannot be retroactive.