Ins Rules
True or False - Medicare Part B allows you to ship to any facility without exceptions.
False, You must ID what type of facility the patient is at and who is paying for the stay.
True or False - A PCA can SUD for the first fill of a patients Ibrance?
False, Nurse will fill the first 2 fills, a PCA can SUD starting on the 3rd depending on if they are part of the monitoring program.
What is a Bridge Program?
A Bridge Program is a program provided by certain drug manufacturers for when a patient’s insurance plan does not cover/approve the prescribed treatment.
What does AOR stand for?
Appointment of Representative or Authorization of Representation
Who handles scheduling of IV Infusion Medication if it is being shipped to the MDO?
PCA
Depending on the circumstances and diagnoses, Medicare part D could also be billed under what?
Medicare Part B
What tool can you use to determine when the earliest date is to ship to a Med B patient?
Date Wheel
How long is the Bridge Program valid for?
12 Months
Where can you see a copy of the medical facilities form allowing BioPlus to fill a patient's Rx?
Images Tab
What insurance plan requires we obtain patient consent to run claims?
Med Impact
What 3 satellite pharmacies can ship to all states for Aetna insured patients?
River Medical, MedScripts, and Route 300
Do Medicare Part D patients qualify for Financial Support if their taking IMIDS medications?
No, pts should be referred to the manufacturer.
What are the 2 copay amounts a patient may pay with Taltz or Olumiant?
$5 or $25 depending on what program they qualify for.
What 3 states Medicaid programs allow you to schedule HVC medications with the doctor’s office without the patients consent?
CT, NH, and WA
True or False -Medicare Part B allows you to ship to any location?
False, only to the patients home.
How many days do you have to ship a medication after resolving the questionnaire if the patient has Medicare Part B?
The CPS Refill Alert Questionnaire must not be resolved more than 7 days from the delivery date.
How do you identify a major medical third-party payor?
Policy names listed in the Third-Party Tab will appear with lowercase letters for major medical claims, whereas Pharmacy claims (electronic claims) will appear all capitalized.
What are 3 medications that use Bridge Program?
Taltz, Olumiant and Otezla.
What step should a PCA take if they revie a callback from a patient wanting to provide verbal consent to run claims?
In the event you received a callback from the patient, obtain verbal consent to run claims, notify the Enrollment team that verbal consent has been obtained.
Where do we direct the patient to for their Taltz pen replacement?
The Lilly Answers Center (TLAC) 800-545-5979
As a percentage, what is the duration of supply needs to be used before Medicaid Part B will allow a PCA to ship the next Rx?
80%
After a Major Medical paper claim is submitted to a plan, how many days does it typically take for it to be processed?
Typically, 30-60 days after submission
What must happen first for a patient to become eligible for the Bridge Program?
Once the PA has been denied.
Can Infusion drugs by administered by a patient?
NO
True or False - If Infusion Medications are being shipped to patient home it is being handled by Nursing.
False