SPECIALTY PHARMACY
Which drug category accounts for the highest drug volume (Traditional vs. Specialty)
Traditional
What are 3 methods of enrolling for a copay card?
Online, over the phone, faxing in a form
What is your “monthly bill” – it is the amount you pay for your health insurance every month
Premium
What are the 2 most common times to enroll a patient?
End of the calendar year and 12 months post enrollment
Humira
hue-MAIR-uh
Which drug category accounts for the highest drug price? (Traditional vs. Specialty)
Specialty
What are 4 different ways to receive a copay card?
Mail, email, verbal, faxed
What is the amount you pay for covered health care services before your insurance plan starts to pay
Deductible
What are different methods of re-enrollment?
Online, over the phone, faxing in forms
Glatiramer
gluh-TEER-uh-mer
What are the 4 different routes of administration of medications?
Oral, inhaled, subcutaneous, intravenous, topical, etc
What are 3 different types of copay cards?
Copay cards, debit cards, and virtual pharmacy cards
What is a fixed amount you pay for a covered health care service after you’ve paid your deductible?
Copayment
What are different types of limits on copay cards?
Annual maxes (funds, # of fills) and monthly maxes funds, quantity, days supply)
Tecfidera
TECH-fih-DARE-uh
What are 3 top disease states?
MS, RA, psoriasis, psoriasis arthritis, Crohn's disease, ulceration colitis, hepatitis c, HIV, oncology conditions, cystic fibrosis, organ transplantation, human growth hormone deficiencies, blood disorders
What are 2 states that have laws that may prohibit copay card usage for the cost of the medication?
California and Massachusetts
What is the percentage of costs of a covered health care service you pay after you've paid your deductible?
Coinsurance
What is the general re-enrollment process for a hepatitis C medication?
Generally no need to re-enroll since pts complete therapy but if needed (eg they let the card expire 6 months post enrollment before finishing therapy, we can call on patient’s behalf to program and re-enroll them and a program director will review the case and give a new card w/ new processing info
Ledipasvir / Sofosbuvir
leh-DIP-us-veer/suh-FOSS-bue-veer
What are 3 medications used for RA?
Actemra, cimzia, enbrel, humira, orencia, simponi, xeljanz, etc
How does Actemra's copay card come and which processing info does the pharmacy use?
A debit card but the pharmacy uses the member ID and bin
What is the most you have to pay for covered services in a plan year?
Maximum out of pocket (MOOP)
How do patients re-enroll into PrudentRx?
They don't
Copaxone
co-PAX-own)