COMMITED TO PATIENT ACCESS

Cost and
Insurance Coverage

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No Cost Eligibility

Depending on your insurance coverage policies ExEm® Foam could be fully covered under your insurance plan. Should your insurance provide this coverage, that may mean you will have no copay, deductible or out-of-pocket costs.*

*Verify with your insurance provider to confirm coverage under your specific individual plan. Fees for ExEm® Foam (and/or the HyFoSy procedure) may apply.

How to Check Your Health Insurance Coverage for ExEm® Foam

  1. Call the customer service number located on your insurance card.
  2. Inform the customer service representative that ExEm® Foam is administered through your provider using the HyFoSy procedure for tubal patency testing.
  3. Ask them to check if ExEm® Foam is covered under the Affordable Care Act.
  4. Provide them with the J code: J3490
  5. Ask if ExEm® Foam is fully covered and the terms and conditions of coverage, or if you will have any out-of-pocket or copay costs.
  6. If ExEm® Foam is not covered under your medical benefit, then it may be covered as a pharmacy benefit. You may call the customer service number on the back of your prescription card to check if ExEm® Foam is covered under your pharmacy benefit.

Patient Copay Assistance Program*

We are committed to supporting the reproductive community with patient access to ExEm® Foam for HyFoSy tubal patency testing. We are pleased to offer a Patient Copay Assistance Program to assist you if you do not have insurance coverage, if you are underinsured or have high out-of-pocket costs. Click the link below to learn more and to apply for this program or call 1.844.205.3607.

* Excludes any and all Federal Health Care Programs.

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Self-Pay

If you do not wish to participate in the Patient Copay Assistance Program and don’t have insurance, or if your insurance doesn’t cover ExEm® Foam, you may self-pay through any pharmacy or one of our preferred pharmacies. Contact our Reimbursement Advisor Team for pharmacy information at 1.888.963.EXEM (3936).