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
- Call the customer service number located on your insurance card.
- Inform the customer service representative that ExEm® Foam is administered through your provider using the HyFoSy procedure for tubal patency testing.
- Ask them to check if ExEm® Foam is covered under the Affordable Care Act.
- Provide them with the J code: J3490
- 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.
- 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.
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).