Commitment Program Terms & Conditions
Program Purpose
The ValorumPRO Commitment Program is designed to support healthcare providers and help maintain patient access during reimbursement implementation and transition periods associated with Valorum product launches.
The Program may provide replacement product for eligible drug claims that receive no reimbursement due to a qualifying reimbursement implementation or administrative processing issue.
Qualifying Event
A Qualifying Event is a reimbursement implementation or administrative processing issue that results in no reimbursement for the drug claim after the healthcare provider has completed appropriate billing, correction, appeal, and/or redetermination efforts, as applicable.
Provider Eligibility Requirements
To be considered for the Program, the healthcare provider must:
- Complete benefits verification and/or prior authorization, when applicable.
- Submit the claim using the appropriate HCPCS code, NDC information, modifiers, units, and other required billing information.
- Make reasonable efforts to correct billing or administrative errors.
- Pursue applicable payer correction, appeal, reconsideration, and/or redetermination processes.
- Provide documentation demonstrating that no reimbursement was received for the drug.
- Provide additional documentation reasonably requested by ValorumPRO to evaluate the request.
Terms & Conditions
- Claims are eligible only when no reimbursement has been received for the drug.
- Receipt of reimbursement for the drug from any payer, patient, assistance program, or other source renders the claim ineligible for replacement under the Program.
- Replacement product is provided solely to replace eligible product associated with an approved claim and to support continuity of patient care.
- Replacement product has no cash value and may not be redeemed, sold, transferred, exchanged, or used for cash, credit, rebate, refund, or other financial consideration.
- Replacement product may not be billed to a patient, payer, government program, or other third party in a manner that would result in duplicate reimbursement.
- Participation and all replacement requests are subject to review and approval by ValorumPRO and Valorum Biologics.
- Submission of a request does not guarantee approval or replacement product.
- Approval of one claim or replacement request does not guarantee approval of any subsequent request.
- Participation in the Program does not require a minimum purchase commitment, exclusivity arrangement, or other purchasing obligation.
- Replacement product provided through the Program will not be included in provider purchase-volume calculations, rebate calculations, contractual purchasing tiers, or other purchasing incentives, unless otherwise expressly permitted by Valorum Biologics.
- Healthcare providers remain responsible for complying with all applicable payer policies, billing requirements, coding requirements, and federal and state laws and regulations.
- Valorum Biologics reserves the right to request additional documentation, deny any request that does not meet Program requirements, and interpret these Terms & Conditions in its sole discretion.
- The Program may be modified, suspended, or terminated at any time, with or without notice, subject to applicable law.
Program Duration
The Commitment Program is generally intended to remain available during the initial reimbursement implementation and transition period following a Valorum product launch.
Program availability and duration may vary by product and may be extended, modified, or discontinued based on reimbursement conditions, payer implementation, or other factors determined by Valorum Biologics.
Additional Limitations
The Commitment Program is not intended to provide routine financial assistance, guarantee reimbursement, subsidize payer obligations, or replace standard payer appeals and reimbursement processes.
Replacement product will be provided only for claims and circumstances determined by Valorum Biologics to meet Program requirements.