Game 1
Why is pre research important?
Know the WHO, WHAT, WHEN, WHERE of the case
Review Case: Know WHO the office contact is, Know WHO the patient is (name and DOB)
Review BIR: Know WHAT insurance, Know HOW the HCP can acquire medication, Know WHAT the benefits are, Know HOW to submit PA (if applicable)
Determine Next Steps: Triage, when HCP will submit/initiate PA (if applicable)
Outline A360 Services: PA follow up (if applicable), SPP follow up (if applicable), DSP, PSP, AZ&Me, etc
True or False: If triage took place, inform the HCP that the SPP will follow up on the PA but A360 will assist (if PAF is on file) with any issues that the SPP may be faced with.
True
True or False: When relaying to Patient, If HIPAA pushback was received but payer trends related to PA coverage, PA submission process and/or contracted SPPs were relayed to patient, please explain that the information provided is based on trends and not by confirming with the payer.
True
This applies to HCP office as well
True or False: We should always ask If HCP office would like A360 to relay result to patent.
True
If HCP or patient states that the patient should not be contacted by A360, update the Okay to Contact Patient box to No.
True or False: If HIPAA pushback received and HCP office agrees to a conference call and benefits are obtained, we would need to create a new BI to document the benefits.
False
True or False: SPP: If patient is eligible but we were unable to enroll due to gatekeeper, inform the HCP they must reach out to SPP directly to resolve.
True
Discuss Buy and Bill
What are the most important points to address when explaining acquisition method to patient?
If HCP will B&B or if the acquisition method is unknown, inform patient that the doctor will determine next steps regarding how the product will be obtained.
If prescription was triaged to SPP for fulfillment, provide SPP name and inform patient that he/she may receive calls from this SPP requesting additional information and/or confirming shipment.
What is the first thing we need to check while relaying to the HCP?
BIR Receipt
True or False: If eligible, HCP can give copay attestation and we can enroll patient in PSP during relay.
True
True or False: We can reactively provide cost share information to the patient.
False
What's the next step to complete if the HCP communication preference has changed?
Send the HCP Communication Update email so the appropriate Patient Access Associate so he/she can update the preference appropriately
When would A360 proactively research a second formulation?
if there is no coverage option for primary formulation, which has to be explained during relay to the office
What are the conditions for PA follow up case to be created after a BI?
1.PAF is on file,
2. HCP requested PA assistance
3. triage didn’t take place
If PSP attestation is not on file and Patient is eligible, What are the next steps to complete?
obtain attestation, enroll patient, explain enrollment and document in PSP case
What's the next step after completing relay to patient and HCP office?
Closing BI by selecting the outcome to reflect the more favorable formulation