PBM
Which two PBMs does SHARx primarily work with the most?
TrueRx & Liviniti
Who do we email regarding TPA issues?
Tonya & Nila
What can be used other than DOB and zip code to verify HIPAA?
Last four of SSN or phone number
Name three biosimilars for Humira
Adalimumab-Adaz (Hyrimoz), adalimumab-adbm (Cyltezo), Adalimumab-ryvk (Simlandi), Adalimumab-gnr (Yuflyma), Adalimumab-bix (Idacio), Adalimumab-atto (Amjevita)
Do specialty medications receive one or two grace fills?
Neither, specialty medications do NOT qualify for grace fills
What are the two VCP pharmacies?
CRx and Encore
Who is Mandy's manager aka who does Mandy report to?
Julie Marsek
Other than controlled substances, what other type of medication cannot be shipped through the mail?
REMS
Mirabegron is the generic for which medication?
Myrbetriq
"75 Variable copay available. Please have patient call 833-439-9617." What does this rejection mean and what do you do when you see it?
This is a Liviniti rejection that means the member must fill their non-SHARx medications thru VCP. If a member’s grace fill(s) or temp fill rejects for VCP, we would just need to request an override from Liviniti.
True or False? Depending on the dx code, TrueRx will cover Wegovy even if the plan excludes WL.
True. Wegovy’s indication was expanded to reduce the risk of major adverse cardiovascular events (MACE) in adults with cardiovascular disease and either overweight or obesity. TrueRx confirmed that they will allow coverage of Wegovy for the indicated patient population for groups who exclude anti-obesity medications
Name one Senior Account Manager.
Tiffany or Garrett
Which J-code list excludes self-injectables?
Minimum Recommended List
Name 1 Stelara biosimilar.
Yesintek
A grace fill will reject if a 30ds exceeds what cost?
$1500
What is ProAct's specialty pharmacy?
Noble
Who do we set the task to for borders members to confirm if there are savings to try for PAP?
Tiffany
What are the first questions we should ask when working on infusions?
Is the medication new, Location of Treatment, does hcp/infusion center accept outside medication, medication Strength, medication Frequency, Quantity needed for each treatment, Length of Treatment, Diagnosis Code.
Name the three types of borders groups and the differences between each.
Borders - Mandatory w/ option, Borders - Mandatory without option, Voluntary Borders.
W/ option, we can attempt PAP. W/out option, we CANNOT attempt PAP. Voluntary, No PAP or CoC requests. High cost meds are covered by the plan, but member can volunteer to utilize MO.
If a member calls requesting to fill 90ds of a medication, that SHARx is NOT assisting with, who do we direct the member to?
Their PBM.
Which PBMs require SHARx to initiate MNRs?
None
Who is the Chief Operating Officer or "COO" of SHARx?
Eric DuBois
Is there a threshold for Limited / Specialty Only groups? If so, what is it?
No, there's not a threshold. All specialty meds will reject regardless of cost.
What group can we NOT do LL/SGHP for?
Washoe County
How would you interpret this rejection 70 ~ PRODUCT/SERVICE NOT COVERED - PLAN/BENEFIT EXCLUSION (THIS DRUG IS ON THE MEDONE LOW VALUE DRUG EXCLUSION PROGRAM & IS EXCLUDED FROM THE MEMBERS PRESCRIPTION DRUG BENEFIT PLAN. CONTACT MEDONE FOR COVERED FORMULARY ALTERNATIVES.)MEMBER TO CONTACT SHARX AT 314-451-3555, ONLY 2 - 30 DAY NON SPECIALTY MEDICATION BRIDGE FILLS ALLOWED?
Total plan exclusion