Call Sheets
This is used to obtain MM benefits (and not get transferred to the PBM)
What is a Jcode?
This part of ADAP handles HIV medications
What is Ryan White Part B?
This is the most common AFP
What is Payor Matrix?
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?
If our medication is not covered, we ask about these
What is other antiretroviral coverage?
These patients only have ADAP (no other insurance)
What is direct dispense?
This document should be updated with suspected AFPs for ACs to further research
What is the CM Playbook?
This is Humana's specialty pharmacy
What is Centerwell?
How long we can leave a Patient on hold
What is 2-3 minutes?
Having this means a copay card will not apply to the out of pocket maximum
If the Patient is insured, we notate ADAP information here on the SOB
What is the comments section?
Alternate Funding Plans are also known as these
What are Specialty Carve Outs?
This ViiV role works with the specialty pharmacies to triage medications
What are the Specialty Pharmacy Liasons?
What is Day 1, 3, and 5?
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?
PAP is reserved for these three Patient types
What are uninsured, underinsured, or Patients who have spent too much on Medicare
We can provide this number on BI calls to obtain INN SPs
What is the pharmacy NPI?
The hold cadence for reaching a payor
What is 20/20/30?
These three plans 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?
The date ViiV stopped providing financial assistance if an AFP is found on a plan
What is November 3rd, 2023?
Express Scripts and Prime Therapeutics use this specialty pharmacy
What is Accredo?
What is the standard MI cadence
What is Day 1, 3, 7, and 9?