Call Sheets
This term is used to obtain MM benefits (and not get transferred to the PBM)
What is a Jcode?
These patients only have ADAP (no other insurance)
What is direct dispense?
These are the three types of SOBs
What are injectable, oral, and pt nav?
This ViiV role works with the specialty pharmacies to triage medications
What are the Specialty Pharmacy Liasons?
How long we have to submit an AE
If our medication is not covered by the PBM, we ask about these
What is other antiretroviral coverage?
If the Patient is insured, we notate ADAP information in this section on the SOB
What is the comments section?
Specialty pharmacy details, tiering exception process, and copay accumulator status goes into this box
What is the comments box?
The specialty contract that ViiV uses is also called this
What is a Limited Distribution Network?
How long we have to complete a BI
What is two business days?
Having this means a copay card will not apply to the out of pocket maximum
ADAP is Part B of this larger program
What is the Ryan White program?
This box is where you will put deductible, cost share, and out of pocket information
What is Explanation Summary?
These two acquisition methods utilize specialty pharmacies to obtain injectable medications
What are Assignment of Benefits (AOB) and the Pharmacy Benefit Manager (PBM)?
How long we can leave a Patient on hold
What is 2-3 minutes?
If the billing is done somewhere other than the provider's office, we ask about this
What is Alternate Site of Care?
The business and plan type we save ADAP cases as in Lynk
What is Other Goverment, Other?
The insurance authorization box requires submission method and this
What is turnaround time (including expedited)?
We can provide this identifier on BI calls to obtain INN SPs
What is the pharmacy NPI?
The cadence for waiting on hold to speak to a payor (not including IVR time)
What is 20/20/30?
These three plan types might require a primary care referral to see a specialist
What are HMOs, EPOs, and POS plans?
This ADAP has its own WI to ensure we get benefits
What is Texas ADAP?
If you have issues with data populating, you might need to create this
What is a manual SOB?
Express Scripts and Prime Therapeutics use this specialty pharmacy
What is Accredo?
What is Day 1, 3, and 5?