Adaptive assist™patient support program

clonoSEQ is a test that measures MRD to help you and your doctor plan for your next step in blood cancer care. clonoSEQ is the first and only FDA-cleared test that detects, counts, and tracks MRD in patients with multiple myeloma, CLL, or B-ALL. It is also CLIA-validated to measure MRD in blood samples from patients with DLBCL and other lymphoid malignancies. Adaptive Biotechnologies is the company that offers clonoSEQ.

Depending on the type of insurance you have, coverage for clonoSEQ testing may differ. Adaptive will bill your insurance company directly and work with your plan to obtain the proper level of coverage for clonoSEQ. If your insurance plan limits or fully denies coverage for clonoSEQ, Adaptive will appeal the claim when possible and work on your behalf to seek payment for testing. You may receive a “Consent to Appeal” form from Adaptive. Please fill it out and return it promptly to help us in appealing for coverage for your test.

In some cases, you may have some out-of-pocket costs, such as coinsurance, for clonoSEQ. Please call our Patient Support Team at 1 (855) 236-9230 to understand your potential out-of-pocket costs, verify your coverage, or discuss payment options. Be sure to talk to your doctor about how clonoSEQ may fit into your treatment plan before initiating testing.

Medicare covers clonoSEQ testing performed on blood or bone marrow samples from patients with multiple myeloma, B-cell acute lymphoblastic leukemia, chronic lymphocytic leukemia, or diffuse large B-cell lymphoma at multiple time points throughout a patient’s treatment.

When there is reason to believe that Medicare will not cover the test, you will be asked to review and sign an Advance Beneficiary Notice (ABN) informing you that Medicare considers the test to be not covered, the reason why testing is not covered, and your financial responsibility, prior to any services being performed. For billing questions or to discuss the Adaptive Assist™ Patient Support Program, please contact our Patient Support Team at 1 (855) 236-9230.

If you don’t have insurance, you can call our Patient Support Team at 1 (855) 236-9230 to get a personalized Good Faith Estimate (GFE).

If you’re eligible, we will attempt to qualify you for financial assistance through our Adaptive Assist Patient Support Program so we can accurately assess your GFE. This will help generate an estimate of the potential cost you’ll be responsible to when receiving a clonoSEQ test.

Out-of-pocket cost estimates are available prior to submission of a clonoSEQ order by contacting our Patient Support Team at 1 (855) 236-9230. The amount quoted during this process is an estimate based on plan benefits and unmet deductible or coinsurance and/or copay amounts and is subject to change based on other claims that are being processed for you.

During the call, we will attempt to qualify eligible patients for financial assistance through our Adaptive Assist Patient Support Program so that we can more accurately estimate the potential out-of-pocket costs.

Yes, Adaptive Assist provides support for out-of-pocket costs if you qualify for financial assistance based on your income or medical expenses. The qualification criteria is in the next FAQ. To see if you might qualify for reduced out-of-pocket costs, please call the Patient Support Team at 1 (855) 236-9230 or print the application form and mail it to:

Adaptive Biotechnologies Corp
PO Box 103250
Pasadena, CA 91189-3250

To be eligible for financial assistance, a patient must meet all of the following criteria:

• Be a US citizen or legal resident age 18 years or older
  • Patients under the age of 18 are eligible but require the application form to be signed by a parent or legal guardian
• Be uninsured or have insurance that does not cover the full cost of clonoSEQ testing
• Meet financial need requirements based on the patient’s income and the number of persons in their household, or meet financial need based on household size, or sum of medical expenses as a percentage of household income
• Please call the Patient Support Team at 1 (855) 236-9230 or complete the application form above to see if you might qualify for reduced out-of-pocket costs
  • NOTE: Patients should be prepared to provide documentation supporting financial need if selected for the program’s eligibility verification process

If you have already received clonoSEQ testing, your insurance company will likely send you an EOB. The EOB is not a bill. It will show what was paid, what deductions were applied, and what part of the total cost is not covered by your insurance. If you have questions about billing or payment, please call our Patient Support Team at 1 (855) 236-9230.

If you received a payment directly from your insurance company for clonoSEQ testing, you are required to forward the payment and related Explanation of Benefits (EOB) to Adaptive Biotechnologies as the provider of these testing services. Please call our Patient Support Team at 1 (855) 236-9230 as soon as possible to learn how to forward the payment and necessary corresponding documents to Adaptive Biotechnologies.

Adaptive Biotechnologies currently offers 3 payment options—phone, online, or mail:

• To pay over the phone by credit card, call our Patient Support Team at 1 (855) 236-9230
• To submit a credit card payment online, visit www.MyLabBill.com/SQ
• To submit a payment via the mail, send a copy of your patient statement for clonoSEQ along with a personal check or money order made out to Adaptive Biotechnologies to the address below

  Adaptive Biotechnologies Corp
  PO Box 103250
  Pasadena, CA 91189-3250

If you have a financial responsibility for clonoSEQ testing, contact us to see if you qualify for financial support.

Adaptive Biotechnologies will perform an upfront eligibility verification of patients applying for financial assistance. You may be required to provide supporting documentation of the financial information provided if your application is selected for review.

You must provide this documentation, such as a W2, paycheck stub, or other such documentation, within 45 days of notification that you have been selected for the process.

Once we review your application along with the documentation you provide, we will send you a letter regarding your program qualification outcome and your level of financial assistance, if applicable. Your approval for financial assistance will be valid for a period of 1 year.

If you have any questions regarding the Adaptive Assist Patient Support Program, please call our Patient Support Team at 1 (855) 236-9230. Representatives are available Monday through Thursday, 9 am to 7 pm; and Friday, 9 am to 5 pm ET.