Team Patients
During verification, when verifying the Dr.'s address, it is important to also do what?
To also confirm the address by searching it on google and confirming again with the patient
We need this document signed before doing DPAs
What is HIPAA
What areas do you check for before setting a BPA?
Key fields, FAS status, medication sales stage
An extra answer: documents
Pt has part D and his program is Novo. What documents do we need
PT: EOB/Pharmacy printout, INS, Part D, and POI
What areas do we look in to qualify patients?
Medication (PAP and OOP), Insurance, and Income
Qualify this patient:
–SS: $4050/month
–3 in HH
–900 OOP
–No Part D
–Medication: BIC
No; over income
What do we need from the patient to do a DPA
Confirmed location of the dr. office, medication name and dosage, prescribing doctor
After a BPA, why do we set a PSC?
We set a PSC to call the program to see if the patient has been approved or not
You received an EOB (OOP: $900) from a patient for her Lantus. She receives $2,041 from SS. Did she meet the OOP?
No. Sanofi is 5% OOP. Pt needs to have an OOP of $1,225
We received all of the required docs from the patient and doctor. What do we change in the patient's CRM?
Key fields, FAS status, and medication sales stage
This should always include:
Who you spoke to
What happened in the conversation
How was the problem resolved
What is a comment?
What DPA:RF would you do for Lilly, GSK, and Bristol?
Lilly DPA reorder form
GSK and Bristol DPA for a new Rx
To set a Refill, we use this button
The green button through the medication
What is the difference between a LIS pre-decisional and final decision letter?
Predecisional letters will have "may not be elligible' and final decision letters will have "you are not eligible"
For DPA/DSC/BPA/PSC/TRK/RF/PR events are set through what?
Through the medication
After billing patients, this button allows you to see the transaction details
What is the small credit card button
What questions should be answered after calling the Dr office?
Did they receive the fax?
Who did you speak to?
How was the issue resolved?
It is important that you have this document up before you call the program
What is R2F2P to see who is authorized to speak on behalf of the patient.
You received a SS letter saying that the patient makes 2,500 per month. with 3 in HH and medication is Eliquis. What should you do next?
Call the patient and ask them if they have any additional income. If they do not, then they have to apply for LIS. If they do have additional income, ask them to fax it to us.
If the patient does not have prescription coverage, do we tell them they need meet an OOP requirement?
No
List the buttons needed to convert patients and their functions
Convert lead>SO/INV>Physmed auto>Ver step 1>Ver step 2
What are the different types of DPAs and what are they used for?
DPA for new and existing patients
DPA:RF for reorder forms or new Rx to place refills
DPA:PR for program renewals when a patient needs to re-enroll into a program
Does J&J ship medications to the patient's home or doctor's office?
Neither! J&J sends a prescription card to the pt and they pick up their medications at a pharmacy
You received an Rx that contains the following:
NPI number
Doctor’s name and address
Medication name and directions
120 day supply with 3 refills
What is missing?
Patient’s name, DOB, and address
and Doctor signature
DOUBLE JEOPARDY
List the steps we complete to attain the medication for the patient and why we set the events for the patient
Note: List the events from the beginning up to the point where we need to re-enroll them to the program
Ver. Attain HIPAA sig. PT/DPA. DSC. BPA. PSC. TRK. RF. PR