SPECIAL HANDLING
WHAT STEPS NEED TO BE TAKEN IF A MEDICATION IS NO LONGER AVAILABLE THROUGH NORTH SCRIPTS?
REFERENCE THEIR PLAN DESIGN TO CONFIRM A COPAY CARD CAN BE APPLIED, REMOVE DENIED DNC AND ISSUE COPAY CARD, CALL MEMBER TO NOTIFY OF THE CHANGE.
SOMEONE CALLS IN STATING THEY ARE WITH THE PROVIDERS OFFICE CALLING TO VERIFY THE PA OR COVERAGE FOR A MEDICATION LISTED AS PAP ON THE DRUG MATRIX, WHAT STEPS SHOULD YOU TAKE?
DO NOT ADVISE ON BENEFITS, COVERAGE OR PA STATUS AND TRANSFER CALL TO AMY, CYNDI OR NYCOLA.
AT WHAT STAGE IN THE CANPATH PROCESS, SHOULD YOU PLACE A DENIED DNC IN AGILE?
AS SOON AS THE TICKET IS ASSIGNED.
WHAT ARE THE THREE STEPS TO ISSUING A COPAY CARD?
DOWNLOAD THE COPAY CARD, ENTER THE OVERRIDES, PROVIDE THE CARD TO THE PHARMACY.
WHAT IS THE FINAL STEP YOU HAVE TO DO BEFORE YOU CLOSE A TICKET?
FILL IN THE COMPLETED ON DATE
IF A UBC MEMBER (EXCLUDING ECTOR COUNTY), DECLINES CANPATH FOR A BRAND (NOT SPECIALTY) MEDICATION, WHAT ARE THE NEXT STEPS?
REFER MEMBER BACK TO PATIENTS CHOICE. THEY WILL NEED TO FILL THEIR MEDICATION WITH RXBENEFITS.
A MEMBER CALLS IN TODAY AND THE MEMBER NEEDS A BRIDGE FILL BEFORE THEY RECEIVE THEIR FIRST SHIPMENT FROM CANPATH - HOW SHOULD THE DNC BE ADJUSTED?
PUSH OUT THE START DATE ON THE DNC 14-30 DAYS TO KICK IN AT A LATER TIME BUT LEAVE THE DNC AS DENIED I.E. 8/1/2025-12/31/2099 DENIED.
WHAT GROUPS HAVE A CANPATH PENALTY?
CANNON MOTORS, AND JACKSON COUNTY.
BONUS POINTS FOR KEESLER FEDERAL CREDIT UNION $1000 DEDUCTIBLE ON MEDICATIONS FILLED DOMESTICALLY.
WHAT IS THE CORRECT STATUS TO USE FOR A PRE LAUNCH GROUP ONCE YOU HAVE ISSUED THE COPAY CARD?
PRE LAUNCH HOLD
YOU ENROLLED A MEMBER IN CANPATH AND SENT THE FORMS TO NORTH SCRIPTS. YOU CALL THE PROVIDERS OFFICE AND THEY ARE CLOSED. WHAT STATUS SHOULD YOU PUT THE TICKET IN?
ENROLLMENT SENT.
IF AN ECTOR COUNTY MEMBER DECLINES CANPATH, WHAT ARE YOUR NEXT STEPS?
REFER MEMBER BACK TO PCARX TO FILL THROUGH THEIR PBM.
YOU RECEIVE A CALL FROM A MEMBER ASKING ABOUT A CANPATH ELIGIBLE MEDICATION BUT NOTICE THE MEMBER HAS A DEDUCTIBLE REQUIREMENT. THE DEDUCTIBLE IS $1000 - WHAT SHOULD YOU DO?
ENROLL THE MEMBER IN CANPATH, $1000 IS NOT A QUALIFIED HIGH DEDUCTIBLE. Anything less than $1,650 is not a qualified high deductible and members can enroll in Canpath.
WHEN CALLING THE PROVIDERS OFFICE TO OBTAIN A PRESCRIPTION WHAT IS THE FIRST METHOD YOU SHOULD PROPOSE TO OBTAIN IT?
ALWAYS TRY FOR A VERBAL PRESCRIPTION FIRST. IF THEY ARE NOT ABLE TO PROVIDE A VERBAL, PROPOSE THE ADDITIONAL METHODS OF FAX, ESCRIBE, ETC.
YOU CALL TO REPROCESS A CLAIM FOR A MEMBER AND THEY SAY THE MEMBER OWES MORE THAN THE COPAY CARD AMOUNT FOR THEIR MEDICATION. WHAT SHOULD YOU DO NEXT?
ENSURE THEY ARE APPLYING THE COPAY CARD - IF THE CARD IS STILL NOT WORKING ESCALATE TO CHAN
YOU GET A NEW TICKET ASSIGNED TO YOU. YOU ATTEMPT TO CALL THE MEMBER AND THE PHONE NUMBER IS DISCONNECTED AND YOU CANT LOCATE ANY ADDITIONAL CONTACT INFORMATION FOR THE MEMBER. WHAT STATUS WOULD YOU USE?
ESCALATION- INVALID CONTACT INFORMATION
WHAT PLAN DESIGN DISQUALIFIES YOU FROM RECEIVING YOUR MEDICATION THROUGH CANPATH?
A QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN (HDHP).
YOU RECEIVE A CALL FROM A PROVIDER CHECKING ON THE STATUS OF A PA FOR A CANPATH MEDICATION- YOU SEE THAT THE PA HAS BEEN APPROVED AND THERE IS AN OPEN TICKET BUT WE HAVENT MADE CONTACT WITH THE MEMBER TO ENROLL THEM. WHAT SHOULD YOU ADVISE THE PROVIDER?
ADVISE THE PROVIDER THAT THE PA HAS BEEN APPROVED, BUT THE MEMBER NEEDS TO CONTACT US IN ORDER FOR A FILL TO BE APPROVED. VERIFY WITH THE PROVIDER THAT WE HAVE THE CORRECT CONTACT INFORMATION ON FILE AND ENCOURAGE THEM TO HAVE THE MEMBER CONTACT US IF THEY SPEAK WITH THEM.
A MEMBER CALLS IN REGARDING A CANPATH ELIGIBLE MEDICATION BUT YOU SEE THAT THEY HAVE A QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN. WHAT STEPS SHOULD YOU TAKE?
EXPLAIN THE CANPATH PROGRAM TO THEM AND ADVISE THAT YOU CAN COMPLETE THE ENROLLMENT WITH THEM BUT THEY WILL NOT BE ABLE TO RECEIVE SHIPMENT THROUGH THE PROGRAM UNTIL THEIR DEDUCTIBLE HAS BEEN SATISIFED.
To be successful in selling this to the member highlight that once their deductible is satisfied, they will default back to their tier copay and this program will allow them to bypass their copay and receive their medication at no cost.
AT WHAT AGE ARE YOU NO LONGER ELIGIBLE FOR A COPAY CARD?
OVER 65
BONUS POINTS FOR UNDER 18
A MEMBER IS ON A HIGH DEDUCTIBLE HEALTH PLAN (HDHP) AND YOU ISSUE A COPAY CARD FOR THEM BUT ARE WAITING FOR THEIR DEDUCTIBLE TO BE SATISIED PRIOR TO ENTERING THE OVERRIDES. WHAT STATUS SHOULD YOU USE?
ELIGIBLE HDHP; PENDING DEDUCTIBLE
WHAT IS THE LIST CALLED THAT ALLOWS YOU TO RECEIVE A SELECT LIST OF MEDICATIONS THROUGH VERUSPATH EVEN WHEN YOU ARE ON A HIGH DEDUCTIBLE HEALTH PLAN, EVEN IF THEY HAVE NOT SATISFIED THEIR DEDUCTIBLE? *HINT* THINK STICKER MULE
EXPANDED PREVENTATIVE LIST
A MEMBER CALLS IN ABOUT A SHIPMENT FROM NORTH SCRIPTS BEING ON HOLD. YOU LOOK UP THE MEMBER IN DYNAMICS AND THEY DO NOT HAVE A PROFILE. WHAT SHOULD YOU DO?
ESCALATE TO JAMEE FOR AN ELIGIBLITY CHECK. ADVISE THE MEMBER THAT YOU WILL ESCALATE TO MANAGEMENT DUE TO AN ELIGIBILITY ERROR AND CALL THEM BACK ONCE IT HAS BEEN RECTIFIED. IF THE MEMBER IS ACTIVE, AND PROFILE CAN BE CORRECTED SEND AN EMAIL TO NORTH SCRIPTS STATING THE MEMBERS ELIGIBILITY HAS BEEN REINSTATED AND ASK THAT THEY SEND THE ORDER FORWARD FOR SHIPMENT APPROVAL TO NYCOLA.
IF A MEMBER DECLINES CANPATH, WHAT ARE SOME WAYS TO REDIRECT THE CONVERSATION FOR THE MEMBER TO ENROLL?
I completely understand, is there a specific reason as to why you would not want to utilize the program? I do want to make sure you are aware that the program is available to you at any time should you change your mind. Quote their tier copay and the savings that will apply to them, especially if there is a deductible requirement or Canpath penalty. Highlight the benefits of utilizing the program such as the convenience to their doorstep. If shipping issues to their home, they can always elect to redirect shipments to their work, or relatives home to receive the free medication offer. Highlight that the program assists in keeping their premiums low when their policies renew.
WHAT IS AN EXAMPLE OF A PLAN DESIGN THAT WOULD DISQUALIFY SOMEONE FROM RECEIVING A COPAY CARD?
WHAT IS A HIGH DEDUCTIBLE HEALTH PLAN, OR A TIER COPAY THAT IS GREATER THAN THE PLANS TIER COPAY.
YOU RECEIVE A CALL FROM A MEMBER REGARDING A CANPATH ELIGIBLE MEDICATION FOR THEIR SPOUSE. WHAT IS THE FIRST THING YOU NEED TO CONFIRM?
THERE IS A HIPPA CONSENT FORM ON FILE AND THE MEMBER CALLING IS AUTHORIZED TO SPEAK ON THEIR SPOUSES BEHALF.