Reimbursement/Insurance Documents

Licart Reimbursement Guide

IBSA Pharma Inc. has developed a reimbursement guide to support healthcare professionals (HCPs) as they navigate coverage, coding, and insurance coverage for Licart® (diclofenac epolamine) topical system 1.3%. The information in this Reimbursement Guide is intended solely as a resource to assist the staff in physicians’ offices with certain insurance-related questions for Licart®.

Provided below are downloadable templates for HCPs to reference and utilize at their convenience for insurance providers on behalf of Licart®. These are not to be sent as is; Fill in patient information as needed.

» Download Sample letter of Medical Necessity
» Sample letter of appeal

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