Formulary Fun
The formulary is the list of what?
The list of medications an insurance covers.
“PA” stands for this.
Prior Authorization.
We use Diclofenac Gel to treat this type of joint condition.
Osteoarthritis.
This pain medicine is used for moderate to severe pain and is sometimes written as “Percocet”?
Oxycodone.
This movie features a friendly green ogre who lives in a swamp.
Shrek
A medication not listed on the formulary is called this.
A non-formulary.
Insurance usually needs to see that the patient has tried and failed at least how many other meds before approving a new one?
Typically two.
Gabapentin is used to treat this type of pain that comes from nerves.
Neuropathic Pain.
This medication is a cream or gel that helps joint pain, often for arthritis.
Diclofenac (Voltaren Gel).
This Disney princess leaves her glass slipper behind at a royal ball.
Cinderella
If the insurance denies a medication, the clinic can send this to fight it.
An appeal letter.
When a medication is not on formulary, the provider can ask for this.
Appeal or Exception
Oxycodone or Hydromorphone are used for this level of pain.
Severe Pain.
This medication helps nerve pain and is often used for sciatica or nerve damage.
Gabapentin.
This animated TV family lives in Springfield and includes Homer, Marge, Bart, Lisa, and Maggie.
The Simpsons
Before submitting a PA, always double-check this list to make sure the medication is allowed.
The formulary.
A strong prior auth includes the diagnosis, medication, and what else?
What has been tried before (trial/fail history).
Cyclobenzaprine (Flexeril) helps relax what?
Muscles.
This pain medication is a patch and often not covered under insurance?
Lidocaine 5% patches.
This actor played Iron Man in the Marvel movies.
Robert Downey Jr.
The purpose of a PA is to make sure the medication is what?
APPROVED, The medication is medically necessary and cost-effective.
True or False: Prior auths are only needed for brand-name medications.
False.
Vyepti or Ubrelvy are used to help people who suffer from frequent ______.
Migraines.
This medication is a non-opioid pain reliever that you can buy over the counter.
Acetaminophen (Tylenol) or Ibuprofen.
This singer is known as the “Queen of Pop” and sang hits like “Like a Virgin.”
Madonna