Eligibility
If a patient doesn't meet this requirement there is no need to apply for the program. This is the minimum requirement.
What is applying for an AbbVie product in the program.
If a patient checks this box, he/she normally doesn't have to worry about submitting POI.
What is the FCRA box?
Medication used to treat Chronic lymphocytic leukemia
What is Imbruvica?
ii caps po bid
What is two capsules by mouth twice a day?
This is an injection under its own program category and normally only shipped to the HCP.
What is Lupron?
A patient must live in the US or its territories
What are the residential requirements for the program?
OOPE Form
What is the form that a patient will submit if over income or if he/she has private insurance?
This is medication used to treat children with central precocious puberty.
WHAT IS LUPRON DEPOT - PED?
We need at least two of these on any prescription for the patient. Name, dob, address are all good examples.
What are patient identifiers
Although you wouldn't know by reading the name, vials are what is being shipped to the patient.
What is RESTASIS OPHTHALMIC ?
Uninsured or underinsured
What are the insurance requirements for the program?
LIS Denial letter
What is the document required if patient has Med D and FPL is less than 150%?
This treats complicated urinary tract infections (cUTI) and pneumonia. HCPs can be reimbursed if they administer from their inventory.
What is Avycaz?
Original with special format & barcode.
What must NY prescribers submit RXs on if medication is going to patient's home?
This is the day supply for Imbruvica
What is 30-day?
400%
What is the percentage of FPL requirement?
We require this if a patient states that his/her private insurance does not cover their medication. It does not include any medical expense information.
What is a PA Denial letter?
This is a glaucoma implant designed to reduce intraocular pressure in eyes
What is Xen?
This is 50% instead of 75% like with most medications.
What is the Lupron exhaustion rate?
A Teflaro patient can only have 60.
What is the maximum boxes per year we can send?
This is when insurance companies require patients to apply for our program to avoid paying medication costs for meds normally available on their formulary.
What is alternate funding?
A PA Denial letter will supersede this document, if an Imbruvica patient submits it for a Med D patient.
What is an ICPAP letter?
Medication to treat heavy menstrual bleeding due to uterine fibroids
WHAT IS ORIAHNN?
For Lumigan, if an HCP writes an RX for 2.5ml we can dispense 7.5ml because this was on the prescription.
What is 2 or more refills?
It doesn't matter what the product matrix says, if this is not checked on the application, the HCP is who will receive the package.
What is the check box indicating send to patient's home? HCP page under product info section 8