Patient Journey:
Let's Go!
Let's Go!
When this section is left blank on the enrollment form, it is considered opted in for this service.
What is section 7/PA assistance?
This process takes place 30 days prior to the expiration date.
What is PA renewal?
This service is not intended for a one-time use of Ruconest.
What are Free Goods?
This is the dedicated person that a CM would reach out to for approval on for the following situations:
-If a patient has received a max of 16 vials of Free Goods
-If a patient has already received 1 Free Goods shipment in the week
-If a patient is requesting PAP
-If a patient is requesting reimbursement
Who is the Pharming Senior Director of Patient Access and Support Services/Melanie Powell (or designee -Operations Manager/Susanna Gelzhiser)?
This team member cannot call in and request PHI from Ruconest Solutions.
Who is the RAM/sales team?
The CM will call this plan if PBM information is missing on the enrollment form.
What is the medical plan?
The CM should typically attempt a Benefits Investigation for this type of insurance plan first.
What are pharmacy benefits?
This program covers out of pocket expenses for RUCONEST for commercially insured patients.
What is the Ruconest Patient Savings Program/copay card?
Ruconest is available at these five Specialty Pharmacies.
What are Accredo, Orsini, CVS, Special Care, & Theracom?
The CM should not close out a patient case without notifying this party first.
What is the Account Team?
Test claims can be ran for patients that have this type of insurance coverage.
What is pharmacy insurance?
When a PA or Appeal approval is received, the CM should notify these three parties.
What are the account team, HCP, and patient?
There are three types of this service offered by Ruconest Solutions named Provisional, Emergency Medicare, and Traditional.
What is PAP?
The checklist prior to this process includes the following:
-Welcome call
-PA approval status
-Valid prescription
-PEF legibility
-Approved Patient Consent version
What is the Triage process?
Signed Patient Consents are required for these types of shipments.
What are Free Goods?
This section being incomplete on the enrollment form is not considered missing information, but can cause a delay at the SP.
What is Section 3 of the enrollment form/Nursing Orders?
In this scenario the CM should attempt to conference in the patient on each attempt.
What is being third partied?
The following are best practices for this process:
-The Section 2 prescription must be complete
-The prescription must be reviewed prior to each request to verify the number of vials needed
-Initial and Subsequent requests can be approved by the RAD
-The location for shipment must be confirmed prior to every delivery
-The specified email template must be used when sending the request for approval
What is Bridge?
This specialty pharmacy accepts the following consent form types created in 2023:
-RUCS-US-2023-0020v2
-RUCS-US-2023-0018v3
-RUCS-US-2023-0019v2
Who is Accredo?
The CM will reach out to this team for steps on next guidance when a patient has expressed financial concern but is not eligible per the requirements.
Who is the account team/Caremetx/Pharming leadership?
These orders can be left blank in the prescription section of the enrollment form, and can be obtained at a later point if patient outreach determines need for it
What are Epinephrine orders?
In this scenario, the CM will:
-Ask if there is a formulary exception available
-Ask for the appropriate letter from the payer
-Request NDP to complete a test claim if available
-Notify Pharming Leadership of findings before sending SOB to HCP
What is the PA not required process?
This approval letter should not be faxed or shared verbally with the provider’s office.
What is the Copay Program Approval letter?
When a patient requests for supplies and has received a dispense from a commercial pharmacy, the CM should be directing the patient to reach out to this party.
Who is the commercial SP they previously received RUCONEST from?
This is a service offered for patients that have opted in and can be utilized when a patient is unreachable via phone call.
What is SMS texting?