2 ways to prescribe Vyleesi
by choosing one of two exclusive specialty pharmacies 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.
First Vyleesi Rx is $0
Each Vyleesi prescription includes 4 autoinjectors. Patients with commercial insurance will receive their first prescription of Vyleesi free. Patients with commercial insurance not covering Vyleesi, or patients without insurance, can still participate through the program’s cash benefit.4†
†Each patient’s eligibility is evaluated on an individual basis. In compliance with federal regulations, patients insured by a government-funded program (Medicaid, TRICARE, etc.) are not eligible. 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.
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 will help lower the out-of-pocket cost to a $0 copay for the patient’s first prescription. Palatin will also provide copay assistance to lower the out of pocket cost for refills to a maximum copay of $99 per 4-pack. Palatin copay assistance will only apply to 2 fills every 30 days. Enrollment into the program cannot be retroactive.