PAP
In order to qualify for PAP, total household income must be equal or less than what % of FPL?
600
f a prescription is sent to us via _________, it is an invalid prescription
When making outbound calls what is required that we inform them?
that we're calling on a recorded line
All specialty pharmacies are mail order however not all mail order pharmacies are specialty pharmacies?
True
How long do CMs have to notify an FRM of a FE or PA denial?
4 hours
What might LIS also be referred to as
Extra Help
Which patients receive a Rapid Access Loading Dose from Pharmacord Pharmacy?
Commercially insured patients
What is the time limit for no verbal interaction (quiet) during a call
no more than 10 seconds
What is the purpose of a tier exception?
Help lower the cost of a higher tiered drug
Who does the CM call to review results of Benefits Investigation?
HCP
What percent of their income must a Medicare patient spend on prescriptions covered by their Part D plan in order to qualify for PAP?
4%
What is the timeline for the program CoPay card lookback period?
90 Days
What is the maximum amount of time a caller can be on hold before being checked in on or spoken to?
60 seconds
How many specialty pharmacies are in our closed network?
16
What 2 pieces of information should be sent to the HCP after a BI follow up call?
Summary of Benefits (SOB) and PA checklist or kit
How long is a PAP approval for an uninsured patient valid?
12 months/rolling calendar
What is the ICD10 code for on label Atopic Dermatitis
L20.9
When verifying a shipping address, what must you clarify?
Is there an apt., suite, or unit number?
If an agent says Adtralza is not covered by the policy, what question should we ask next?
Is a formulary exception allowed?
Case managers will follow up with Payor after HCP confirms submitting on which days?
2 days after confirming, then day 4 and 6
How long is a PAP approval for a patient with Medicare?
Until Dec. 31 of the current year
A commercially insured patient who is actively seeking coverage for Adtalza can receive bridge care shipments of the medication for up to ___________
2 years
Name the 3 pieces of information acceptable to use to verify HIPAA?
patient full name, patient d.o.b. and patient zip code
When calling the payor, who is the CM calling on behalf of?
The patient
When should a CM follow up with HCP regarding submission of PA or FE?
Days 1,3,5