Managed Care 101
What is a form of utilization management requiring health care providers to obtain approval from health insures in order for a drug to be covered for appropriate patients?
Prior Authorization
T/F Nurtec is indicated for Chronic Migraines
False
How many $0 copay do you get for Zavzpret TRx for a commerical patient?
1
Which three places can you find print on demand?
CnC Tool, AGI & Veeva Media
How many $0 copay fills do you get for Nurtec TRx without a PA for commercial patients?
1
What is a form of utilization management requiring patients to first try and fail the lower-cost drugs preferred by health plans before "stepping up" to the physician's recommended therapy?
Step Edit/Step Therapy
Which five plans have no Step Therapy for Nurtec EOD?
Aetna, Anthem, Cigna, Express Scripts & CVS Caremark
What resource can you hand your HCP for Nurtec & Zavzpret Managed Care information?
Understanding Access for Nurtec ODT and Zavzpret
What are two places you can find managed care data for Nurtec specific HCPs?
AGI & Smart 1.0
Where are two places you can submit a FAL triage?
What is the highest amount of a prescription drug that can be dispensed by the pharmacy in a designated period of time?
Quantity Limits
Which four National Commercial Plans can you get Nurtec 16PRN?
Express Scripts, CVS Caremark, Aetna & Cigna
A MA asks you the Zavzpret criteria for a small employer plan that you don't have on your CnC tool, what do you do?
What is where you can view overall access in your geography, explore and evaluate individual HCP payer mix, pull customer target lists and view new payer wins.
Access Genius Insights
What is in individual who is enrolled in a federal health insurance program who primarily covers individuals aged 65 and older, some younger individuals with certain disabilities and those with end-stage renal disease?
Medicare
What is a formal document explaining why a patient needs a specific treatment. It's typically written by a licensed healthcare providers and includes information about the patient's diagnosis, duration of treatment, and the clinical rationale for treatment.
Letter of Medical Necessity
Dr Fankboner received a Nurtec denial letter, she asks you the rep for help, what do you do?
Refer to FAL
Which Pfizer employees can speak directly to patients?
What is a public health insurance program for some people or families with limited incomes and resources, including children, pregnant women, older adults and people with disabilities?
Medicaid
What program helps financially needy patients to purchase necessary medications and supplies?
Patient Assistance Program
How many headache days are considered a prevention patient?
More than 4, less than 15