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.
What is the day supply for QS and CI?
15 days
Where can I find the definition of different statuses?
On the reports tab
What documents can you find in the portal?
Insurance cards, denial letters, LOMN, and clinicals
What is always needed before proceeding with any case?
Patient consent
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)
How many QS's and CI can a patient receive?
up to 4 (15day) supplies
Where can I find graphs and metrics pertaining to the program?
Performance matrix
Who do you contact when you need to reset your password for the portal?
Program manager: Melissa <3
What is the time frame to triage a script received to an SP?
4 hours
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
What is the main difference between QS and CI?
QS is for new patients and CI is for existing patients
What is the purpose for the alerts tab in the portal?
To alert BPM if YBP requires intervention to reach a HCP
What information would you expect to see in the welcome call outcome note
Initial reach out to patient after receiving new referral
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.
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.
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.
Which tab will tell me if the claim is impacted by an AFP?
Benefits and coverage tab
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.
What pharmacies can dispense Ayvakit?
1. Biologics
2. Onco
3. IOD
4. Caremed (free good only)
What is financial guideline for Part D patients?
at or below 300% FPL and 4% cost sharing
For patients eligible for QS, the delay must be how long?
beyond 5 business days
What tab would I go to see what free goods the patient applied for?
Free good dispense info tab
False - only those with PHI clearance
If patient is eligible for copay card, patients pay as little as $0 for Avyakit with annual maximum of $______
$25,000