PAP
Quick Start/Coverage Interruption (bridge)
Portal 1
Portal 2
Random
100

Once a patient is approved for PAP, what letters (word merges) are sent?

1. PAP shipment notification to MDO upon scheduling delivery

2. PAP shipment approval letter to patient (either straight PAP letter OR MCR-D letter) upon scheduling delivery.


100

What is the day supply for QS and CI?

15 days

100

Where can I find the definition of different statuses?

On the reports tab

100

What documents can you find in the portal?

Insurance cards, denial letters, LOMN, and clinicals

100

What is always needed before proceeding with any case?

Patient consent

200

What are the 3 different PAP types (buckets) that a patient must fall under to be eligible?

1. Uninsured (No insurance)

2. Functionally Uninsured (PA Denied)

3. Underinsured (Financial)

200

How many QS's and CI can a patient receive?

up to 4 (15day) supplies

200

Where can I find graphs and metrics pertaining to the program?

Performance matrix

200

Who do you contact when you need to reset your password for the portal?

Program manager: Melissa <3


200

What is the time frame to triage a script received to an SP? 

4 hours 

300

How is proof of income verified?  

Utilize Experian as source of truth unless contested by patient or if data is unusable. 

If patient contest they can submit most recent tax return

300

What is the main difference between QS and CI?

QS is for new patients and CI is for existing patients 

300

What is the purpose for the alerts tab in the portal?

To alert BPM if YBP requires intervention to reach a HCP

300

What information would you expect to see in the welcome call outcome note 

Initial reach out to patient after receiving new referral 

300

When an RX needs to be triaged, how do we determine where it is sent to? 

1. preference listed on PEF

2. if there is no pref, then send via round robin. 

400

How many insurance denials are required before reviewing for PAP?

As many as the plan will allow. Must exhaust all internal and external options, but not at the state level.

400

Can a patient who has been off therapy for 3 months qualify for CI?

No, as the CI is only for a lapse in current therapy.

400

Which tab will tell me if the claim is impacted by an AFP?

Benefits and coverage tab

400

How can I communicate with a case manager in the portal?

Go to case note tab and create a note and post. An alert will be sent to case manager in shared inbox. Territory case manager will respond.

400

What pharmacies can dispense Ayvakit? 

1. Biologics

2. Onco

3. IOD

4. Caremed (free good only)

500

What is financial guideline for Part D patients?

at or below 300% FPL and 4% cost sharing

500

For patients eligible for QS, the delay must be how long?

beyond 5 business days

500

What tab would I go to see what free goods the patient applied for?

Free good dispense info tab

500
TRUE/FALSE: everyone can see case notes in BluePrint portal

False - only those with PHI clearance 

500

If patient is eligible for copay card, patients pay as little as $0 for Avyakit with annual maximum of $______

$25,000

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