PAP
What is the FPL for the program?
500%
What is the days supply for QS?
7 days
What is the days supply for bridge?
7 days
What lists can we call out of to schedule deliveries?
List A and List B ONLY
What must be on file before we can proceed with any case?
Patient consent
What are the pap buckets (types)?
1. Uninsured
2. Financial
3. PA Denied
How many QS's can a patient receive?
up to 4 (7 day) supplies.
How many bridge supplies can a patient receive?
up to 4 (7 day) supplies
What lists are monthly verifications ran out of?
List 3 or list B ONLY
How can consent be obtained?
Verbal, enrollment form, docu-sign
Can we service off label patients?
Yes, for PAP ONLY
When is a QS offered?
if there is an insurance delay of at least 5 business days for patient's who are brand new to therapy.
When is bridge offered?
for any delay in a pt's current therapy. (ex: insurance change, lost their meds, travel, dose change)
-if the disruption in insurance will lead to delay of therapy exceeding 5 business days.
When are communication patient and MDO notes used?
for any inbound calls or the 2nd outreach of the day to either pt or MDO.
Who qualifies for a copay card? What is the copay? and what is the annual max?
1. On label, Commercial insurance, payable claim.
2. $0
3. $25,000 annual max
How many denials are needed for PAP, if not covered by plan?
3 total coverage denials
Can QS be offered to a patient with breast cancer?
No, on label ONLY.
Can bridge be offered to a patient with prostate cancer?
Yes, bridge can be offered to pt's on or off label as long as they meet the other criteria.
What is the onboarding process?
1. hub inquiry
2. User defined field
3. referral source
4. referral confirmation
5. PDF docs received
6. BV if consent on file
Who dispenses the non-commercial product?
Caremed (dispenses free good ONLY)
Can an over-income patient still qualify for PAP?
yes, will submit request as a PAP - appeal. Will need a Financial hardship letter from the patient or provider.
What progress note is used for the first quick start submitted?
Quick start - initiated
What last event once a bridge request has been submitted to MFG do we use?
Pending MFG approval
What is the process for logging a free good approval?
In no particular order:
1. Pop up
2. Payor
3. Progress note
4. Service review
5. change payor and push order to list 4 (order complete)
6. For Aveo, send either QS or PAP approval notification fax.
7. Email Hub esc.
Who dispenses the commercial product?
Biologics, Onco or IOD