SP Notes
How can a case manager assist when a patient is "pending scheduling" with a specialty pharmacy?
Call or text the patient and advise that they are ready to schedule (extra kudos if you offer to warm transfer and stay on the line while the patient is scheduling)
Put the patient's information on the triage tracker
What is the SPL preferred communication method?
Who do we need approval from before we can triage Quickstart?
Leadership/CSL
the SPL does not have an SP contact for this medication and specialty pharmacy
Accredo-Berinert
How can a case manager assist when a patient is "pending RX clarification" with a specialty pharmacy?
Fax or call the HCP to advise RX clarification is needed with the specialty pharmacy (extra kudos if you offer to warm transfer to the specialty pharmacy)
Where is the triage tracker located?
In the shared case tracker spreadsheet under the tab labeled "SP Triage Tracker"
What is a case manager supposed to use when emailing the SPL?
SPL email template
True or False: Bridge and QS fills require a new triage with every fill
TRUE
True or False: The SPL needs to be CC'd on bridge request emails sent to Justin
FALSE
What can a case manager offer to the patient if they have a high copay with government insurance?
Foundation Information
Name two out of the three types of patients that get put on the triage tracker
•Naïve Patients- Patients that have never been on medication (Haegarda/Berinert) before (excluding quickstart)
•Restart Patients- Patients who have not filled in 90 days
•Patients that have had a change in specialty pharmacy- due to an insurance change or change within their plan’s contracting
KUDOS IF YOU GOT ALL THREE!
What is one out of the two exceptions to not having to ask the SPL permission to call a specialty pharmacy?
When the case manager has a patient or HCP on the line
OR
When the case manager has to follow up on shipment status for a Berinert Accredo patient
KUDOS IF YOU GOT BOTH!
Which specialty pharmacy has a separate triage tracker to itself?
Covermymeds
What can you have the patient sign in order to get shipment updates from Accredo?
Universal HIPAA consent form
How long do the specialty pharmacies have to complete their benefit verification process?
48 hours (2 days)
What is needed for a case manager to triage a new patient to a specialty pharmacy?
HIPAA consent OR PA approval
What technology method does the SPL typically use to run the SP meetings?
Teams
Who assists in tracking when a patient's next Quickstart or Bridge fill should be?
Candi
What can a case manager look into with the plan if the patient's copay is high?
Copay Maximizers
What does is mean when a patient is "pending a quantity override" with the specialty pharmacy
When a quantity override is needed, this means that the prior authorization was not approved for the correct monthly vial quantity according to what is needed to fill the prescription.
Ex: Patient needs 16 vials of the 3,000IU monthly, but PA was only approved for 10 vials of the 3,000IU monthly.
Name two out of the four types of patients that do not get put on the triage tracker
•Off label Patients- Patients with a DX code of anything other than D84.1
•Reauthorization Patients- patients that are currently on medication and are reauthorizing their prior authorization and have filled within the past 90 days
•VA Patients- Patients with VA insurance served in the active military, naval, or air service and didn't receive a dishonorable discharge
•Kaiser Patients- a membership-based, prepaid, direct health care system.
KUDOS IF YOU GOT ALL FOUR!
The SPL compiles a list of outreach requests for the case managers every Wednesday. What report are these outreach requests for?
RTD (Referral to Dispense)
What is the Berinert Loyalty program called and which specialty pharmacy can fill?
Assurance- Covermymeds
What are the 7 specialty pharmacies that can fill Haegarda
Humana
Optum
CVS
Accredo
Orsini
Alliance
Option Care