Get The Ball Rolling!
Patients deemed eligible and approved for Quick Start are permitted to be on the program for up to ___
What is 60 days
If a patient is ineligible for PAP, the case may be escalated to this person for review.
Who is
the Head of Patient Services? (Jessica G.)
Patients must meet this income threshold to qualify for PAP if uninsured.
What is
≤700% of the Federal Poverty Level (FPL)?
What triggers a KOC escalation to the field?
What is
PAL has attempted HCP contact 3+ times
No more than ___________ per quarter per patient
What is
one (1) replacement vial
Once insurance delay is confirmed a ___ supply of medication is shipped to patient.
What is one-week (2 vials)
This exception allows additional vials for government-insured patients during December renewals.
What is
the Year-End Renewal Exception?
Name two conditions that qualify a commercial patient as functionally uninsured under SOP-0389.
What are
benefit exclusion and exhaustion of prior authorizations and appeals?
How do PALs notify CSS team regarding escalation
What is
Email To: Sales Team within the dropdown selection.
For replacement requests, the Patient access lead will collect the necessary information from the patient and submit the ___ ___ ___ for approval or denial.
What is
Product Replacement Request in PJN
May be offered Quick Start once a patient's prescriber has submitted a Prior Authorization to the patient’s insurance company and the Patient Access Lead has determined a delay in insurance coverage through contact with to the patient’s plan or specialty pharmacy.
What is Commercially Insured Patients
Government-insured patients must apply for this program before PAP enrollment.
What is
the Extra Help program?
This role verifies Medicaid eligibility and conducts monthly benefit checks.
Who is the Patient Access Lead (PAL)?
When completing contact attempt for escalations to field, do not include ___
What is
PHI
User reports non-compliance with temperature parameters in label and internal stability data such as delivery left out too long/not refrigerated in a timely manner; a broken refrigerator; or patient removed a dose to prepare and forgot about it/ accidentally left it out of the refrigerator too long.
What is
Temperature Excursion
These patients must wait at least five (5) business days after the submission of the Prior Authorization or a Prior Authorization denial.
What is Government Insured Patients
This term refers to patients with insurance but no coverage for Kiniksa products.
What is functionally uninsured?
Name one acceptable form of income verification besides electronic verification.
What is
a tax return, W-2, SSA-1099, or pay stubs?
Field team reports off this data and will follow up with office when alerted
What is
Contact attempt -> CSS/RSD Support Need = Yes
The completed prescription will be submitted to NCP (TC Script) by the patient's prescriber via 1 of the 3 methods, name all 3 methods:
What is
electronic prescription, fax, or oral (telephone) order.
The patient must meet the following 3 program guidelines to be placed on Quick Start:
What is
4.1.1. The patient is currently prescribed a Kiniksa Product for an FDA approved indication
4.1.2. The patient is currently under the treatment of a U.S. licensed healthcare professional
4.1.3. The patient lives in the U.S. or a U.S. territory
What additional shipment quantities are allowed under the Year-End Renewal Exception for PAP?
What is
1 vial for 3rd week of December and 2 vials for 2nd week of December?
Patients in states with expanded Medicaid and income ≤138% FPL must provide this document for PAP enrollment.
What is
a Medicaid denial letter?
PAL has attempted contact 3+ times What are the 3 categories/reasons as why a PAL would escalate to the field?
What is
(for enrollment paperwork, missing info, or reimbursement support).
Product eligible for replacement includes 4 categories:
What is
1. temperature excursions
2. damage
3. improper mixing
4. or unforeseen events