Initial Fill
The PPS will mirror the channel source for this case
What is the parent BV case
Refills will always have this channel source
What is Valet/BVA
We use this reason code when transitioning a refill bridge case to commercial coverage
What is Bridge Ineligible insurance change
Not eligible is a reason code closure for this case type
What is a PPS
This denial reason includes trial and failure to steroid topicals
What is First Line Therapies
The patient must be enrolled in these services to be eligible
What is Complete Services
The dose number is located here
What is the Care Program or Case History
We send these letters when transitioning a patient to commercial coverage
What is BVS HCP, BVS Patient, Bridge to Commercial HCP & PT
The patient must be this age or younger to be bridge eligible
What is 63 years old
This denial reason includes trial and failure to other biologics
What is step therapy
This process is for a BNR plan
What is 1,3,5
The case type starts out as this for every refill
What is a benefit verification
The outbound calls made
What is to patient, HCP, Nurse Amb
This PA denial reason is not bridge eligible
Missing information
Appeal requirement met with HCP saying they submitted the appeal
What is an appeal attestation
This identifier has 100% coinsurance with no deductible and no OOP
What is an AFP/PAP maximizer
We add this prior to flipping the case to a Patient Program Support
What is a Member Benefit
A transition fill is provided under these circumstances
What is no PA approval on file with less than 5 days remaining or AFP discovered
HCP will be required to accept these T&C for patient to be bridge eligible
What is the 180 day appeal requirement
The PPS case is closed with this reason code when HCP fails to submit appeal requirement by day 5
What is Not Eligible
The Support Program requires this in order to generate
What is a member benefit
The date this particular case was closed determines the bridge start date
What is the first PPS case closed as B-bridge approved faxed to pharmacy
Parent case to this case
What is the first PPS B-Bridge approved
These diagnoses are FDA approved (on-label) for Skyrizi
What is Ps, PsA, CD
Patient may be referred/eligible for this program if the PA denial states missing labs and step therapy
What is Bridge (considering all other requirements met)