Navigating Cost & Coverage Resources
Resources to support clinics with understanding and managing the coverage, reimbursement, and cost requirements involved in delivering iCAB/RPV.
They offer practical guidance and tools for staff who support patients through insurance navigation, financial assistance, and related workflow needs.
Letter & Document Templates
These resources are intended to support staff in navigating the full iCAB/RPV coverage and cost-support process. Examples of appeals, denial responses, letters of medical necessity, claims language, and prior authorization materials included in this resource are intended as adaptable templates. The materials include screenshots and overviews of each required form. They outline the type of information needed at each step of the navigation workflow, helping staff efficiently guide patients through benefits verification, prior authorization, financial-assistance programs, and related documentation.
Supplemental Resource: Appeal Letter Template
Overview of iCAB/RPV Coverage Reimbursement and Cost
This training resource is intended for administrators and clinical staff at sites that are considering or developing iCAB/RPV programs. It supports teams in understanding coverage pathways, reimbursement considerations, cost-recovery strategies, and potential financial obligations for patients and clinical settings. The resource provides an orientation to the essential issues surrounding iCAB/RPV coverage, reimbursement, and cost. It can be reviewed individually or used as a presentation for staff who play a role in planning, budgeting, or sustaining an iCAB/RPV program. The content walks through payment options, patient-assistance mechanisms, and operational factors that influence program viability.
Cost & Coverage Flow Chart
This flowchart is designed to help clinics and community-based organizations understand the coverage and cost processes involved in iCAB/RPV care delivery. It can also support teams in evaluating their workflow and staffing capacity to manage cost and coverage considerations at each stage. Informed by ALAI UP’s work with eight clinical demonstration sites nationwide, it highlights flexible approaches to iCAB/RPV program delivery. This flowchart does not represent any single clinic, policy environment, or patient population. Instead, it is intended as a directional tool to guide program development.