RE: PRESCRIPTION COVERAGE

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Dear Melisa,We generally call the Insurance Company, and ask for the RX coverage plans, and look through the different tiers for what is, and is not covered brand, and generic.The patient is then advised from there.Thanks,DorindaDorinda S. Frye, ARC RepDFrye@...Hematology/Oncology AkronHematology/Oncology Mahoning ValleyInfusion TherapyCraniofacial Office FaxTrammell Melisa Trammell Melisa Sent by: <TxFinancialCoordinators >01/15/2010 08:59 AMPlease respond to<TxFinancialCoordinators >To " TxFinancialCoordinators " <TxFinancialCoordinators >ccSubject PRESCRIPTION COVERAGE Good morning! I am going to start obtaining the prescription coverage in my office. Prograf, Myfortic, Bactrim, Colace, Mycelex, and Valcyte are the common meds. How do you know which Meds are which tiers and we don’t know which dosage is going to be prescribed, so how do you give the patient an idea of what the costs are? What questions do you ask? Is there a general way to go about this? Missy Trammell-Transplant Financial Coordinator Research Medical Center 6400 Prospect, Ste 328Kansas City, MO 64132 phone fax melisa.trammell@...

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is this how it's done ?From:To:<TxFinancialCoordinators >Date:01/15/2010 08:07 AMSubject:Re: PRESCRIPTIONCOVERAGESent by:TxFinancialCoordinators Dear Melisa,We generally call the Insurance Company, and ask for the RX coverage plans,and look through the different tiers for what is, and is not covered brand,and generic.The patient is then advised from there.Thanks,DorindaDorinda S. Frye, ARC RepDFrye@...Hematology/Oncology AkronHematology/Oncology Mahoning ValleyInfusion TherapyCraniofacial Office FaxTrammellMelisa Trammell Melisa Sent by: <TxFinancialCoordinators >01/15/2010 08:59 AM Please respond to<TxFinancialCoordinators >To " TxFinancialCoordinators " <TxFinancialCoordinators >ccSubject PRESCRIPTION COVERAGEGood morning! I am going to startobtaining the prescription coverage in my office. Prograf, Myfortic, Bactrim,Colace, Mycelex, and Valcyte are the common meds. How do you know whichMeds are which tiers and we don’t know which dosage is going to be prescribed,so how do you give the patient an idea of what the costs are? What questionsdo you ask? Is there a general way to go about this?Missy Trammell-Transplant Financial CoordinatorResearch Medical Center 6400 Prospect, Ste 328Kansas City, MO 64132 phone fax melisa.trammell@... [attachment " pic21881.gif " deleted by S Chaney/Surgery/UNMC/UNEBR] [attachment " C0845245.gif " deleted by S Chaney/Surgery/UNMC/UNEBR] [attachment " C5115995.gif " deleted by S Chaney/Surgery/UNMC/UNEBR]

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When we are asked about Rx coverage, we can assist with the information only, and refer them to their Insurance and if need be show them how to read the tiers if they have a tier plan Rx. We have had patients who need prior auth for Rx and yes we do do that if it is related to services and care.Does anyone else do something different?Dorinda S. Frye, ARC RepDFrye@...Hematology/Oncology AkronHematology/Oncology Mahoning ValleyInfusion TherapyCraniofacial Office Fax S Chaney Sent by: <TxFinancialCoordinators >01/15/2010 09:39 AMPlease respond to<TxFinancialCoordinators >To<TxFinancialCoordinators >ccSubjectRe: PRESCRIPTION COVERAGE is this how it's done ? To: <TxFinancialCoordinators > Date: 01/15/2010 08:07 AM Subject: Re: PRESCRIPTION COVERAGE Sent by: TxFinancialCoordinators Dear Melisa,We generally call the Insurance Company, and ask for the RX coverage plans, and look through the different tiers for what is, and is not covered brand, and generic.The patient is then advised from there.Thanks,DorindaDorinda S. Frye, ARC RepDFrye@...Hematology/Oncology AkronHematology/Oncology Mahoning ValleyInfusion TherapyCraniofacial Office FaxTrammell Melisa Trammell Melisa Sent by: <TxFinancialCoordinators > 01/15/2010 08:59 AM Please respond to<TxFinancialCoordinators >To " TxFinancialCoordinators " <TxFinancialCoordinators > ccSubject PRESCRIPTION COVERAGEGood morning! I am going to start obtaining the prescription coverage in my office. Prograf, Myfortic, Bactrim, Colace, Mycelex, and Valcyte are the common meds. How do you know which Meds are which tiers and we don’t know which dosage is going to be prescribed, so how do you give the patient an idea of what the costs are? What questions do you ask? Is there a general way to go about this? Missy Trammell- Transplant Financial Coordinator Research Medical Center 6400 Prospect, Ste 328 Kansas City, MO 64132 phone fax melisa.trammell@... [attachment " pic21881.gif " deleted by S Chaney/Surgery/UNMC/UNEBR] [attachment " C0845245.gif " deleted by S Chaney/Surgery/UNMC/UNEBR] [attachment " C5115995.gif " deleted by S Chaney/Surgery/UNMC/UNEBR]

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Our process is a little different.We have pharmacy financial counselors. We initially call the pharmacy helpdesk for that plan to obtain the copay structure. Sometimes the help deskis more beneficial in finding out the truth about the copay structure,sometimes they are not. If they are not helpful, then we try the medicalaspect of the plan.Initially, we ask for thecopay structure. Example: Generics $5, Preferred brands $25, Non-preferredbrands $50 for a 30 day supply at a retail pharmacy. Then if thereis a mail order option with saving benefit and who that is through andwhat that structure is. Always ask if there is an annual deductible orout of pocket max/cap benefit for prescription meds. Some plans,especially if you’re talking to the medical side, get confused and willtell you the medical deductible/out of pocket. It is also beneficial toask where the pt is at in regards to those figures.At that point, we hit thekey meds: Prograf, Cellcept, and Valcyte. A plan 95% of the time can tellyou what the copay for those medications are. Our standard is Prograf 1mgcaps, 5mg twice daily: ie 300 caps for a 30 day supply; Cellcept 250mg,1000mg twice daily (240/30), Valcyte 450mg, 900 mg daily. At this point,the representative can either run a test claim and tell you the copay,or check the insurance drug formulary list and tell you where those medsfall. Since there is not a generic available for Valcyte, it is alwaysa Brand, Non-formulary brand or Specialty medication. Since Prograf andCellcept now have generics available, it is essential to ask if there isa penalty or auxiliary fee for the pt to receive the brand version of themedication versus the generic and if the doctor writing DAW (dispense aswritten) affects that copay/penalty fee. The fee is typically the cashdifference between the cost of the generic medication and brand medication,which for Cellcept turns out to be between a $600-$900 difference. Sincewe’re calling from the pharmacy end, we also ask if those medicationsrequire a prior authorization or need to be filled at a specialty pharmacyto help ease our discharges post transplant.For added information, knowingif the policy is a mandatory generic policy or mandatory mail order formaintenance meds is beneficial for the patient. The majority of the remainingmedications on our protocol easily fit into the copay structure. Colacewould be either over the counter or generic (which may or may not be coveredbut is fairly inexpensive. Bactrim is a generic and would be the genericcopay and so on and so forth.That is a quick rundown ofour process. I’d always be more happy to go into more detail if necessaryand feel free to contact me with questions. Best of luck!!Jennie GollehonPharmacy Financial CounselorPhone: Email: jgollehon@...Nebraska Medical Center, Omaha,Nebraska From: S Chaney Sent: Friday, January 15, 2010 8:42 AMTo: Gollehon, Jennie ASubject: Fw: PRESCRIPTION COVERAGE is this how it's done ? ----- Forwarded by S Chaney/Surgery/UNMC/UNEBR on 01/15/2010 08:42AM ----- From:To: <TxFinancialCoordinators >Date: 01/15/2010 08:07 AM Subject:Re: PRESCRIPTIONCOVERAGE Sent by:TxFinancialCoordinators Dear Melisa,We generally call the Insurance Company, and ask for the RX coverage plans,and look through the different tiers for what is, and is not covered brand,and generic.The patient is then advised from there.Thanks,DorindaDorinda S. Frye, ARC RepDFrye@...Hematology/Oncology AkronHematology/Oncology Mahoning ValleyInfusion TherapyCraniofacial Office FaxTrammell Melisa Trammell Melisa Sent by: <TxFinancialCoordinators >01/15/2010 08:59 AM Please respond to<TxFinancialCoordinators > To " TxFinancialCoordinators " <TxFinancialCoordinators >ccSubject PRESCRIPTION COVERAGE Good morning! I am going to startobtaining the prescription coverage in my office. Prograf, Myfortic, Bactrim,Colace, Mycelex, and Valcyte are the common meds. How do you know whichMeds are which tiers and we don’t know which dosage is going to be prescribed,so how do you give the patient an idea of what the costs are? What questionsdo you ask? Is there a general way to go about this?Missy Trammell-Transplant Financial CoordinatorResearch Medical Center 6400 Prospect, Ste 328Kansas City, MO 64132 phone fax melisa.trammell@... -------------------------------------------------------------------------This message was secured by ZixCorp®.The Nebraska Medical CenterE-mail Confidentiality DisclaimerThe information in this e-mail may be privileged and confidential, intendedonly for the use of the addressee(s) above. Any unauthorized use or disclosureof this information is prohibited. If you have received this e-mail bymistake, please delete it and immediately contact the sender.From:To:<TxFinancialCoordinators >Date:01/15/2010 08:49 AMSubject:Re: PRESCRIPTIONCOVERAGESent by:TxFinancialCoordinators When we are asked about Rx coverage, we can assist withthe information only, and refer them to their Insurance and if need beshow them how to read the tiers if they have a tier plan Rx. We have hadpatients who need prior auth for Rx and yes we do do that if it is relatedto services and care.Does anyone else do something different?Dorinda S. Frye, ARC RepDFrye@...Hematology/Oncology AkronHematology/Oncology Mahoning ValleyInfusion TherapyCraniofacial Office FaxS Chaney Sent by: <TxFinancialCoordinators >01/15/2010 09:39 AM Please respond to<TxFinancialCoordinators >To<TxFinancialCoordinators >ccSubjectRe: PRESCRIPTION COVERAGEis this how it's done ? From:To: <TxFinancialCoordinators >Date:01/15/2010 08:07 AMSubject:Re: PRESCRIPTIONCOVERAGE Sent by:TxFinancialCoordinators Dear Melisa,We generally call the Insurance Company, and ask for the RX coverage plans,and look through the different tiers for what is, and is not covered brand,and generic.The patient is then advised from there.Thanks,DorindaDorinda S. Frye, ARC RepDFrye@...Hematology/Oncology AkronHematology/Oncology Mahoning ValleyInfusion TherapyCraniofacial Office FaxTrammellMelisa Trammell Melisa Sent by: <TxFinancialCoordinators >01/15/2010 08:59 AM Please respond to<TxFinancialCoordinators >To " TxFinancialCoordinators " <TxFinancialCoordinators >ccSubject PRESCRIPTION COVERAGEGood morning! I am going to startobtaining the prescription coverage in my office. Prograf, Myfortic, Bactrim,Colace, Mycelex, and Valcyte are the common meds. How do you know whichMeds are which tiers and we don’t know which dosage is going to be prescribed,so how do you give the patient an idea of what the costs are? What questionsdo you ask? Is there a general way to go about this?Missy Trammell-Transplant Financial CoordinatorResearch Medical Center 6400 Prospect, Ste 328Kansas City, MO 64132 phone fax melisa.trammell@... [attachment " pic21881.gif " deletedby S Chaney/Surgery/UNMC/UNEBR] [attachment " C0845245.gif " deleted by S Chaney/Surgery/UNMC/UNEBR] [attachment " C5115995.gif " deleted by S Chaney/Surgery/UNMC/UNEBR] [attachment " pic13966.gif " deleted by S Chaney/Surgery/UNMC/UNEBR] [attachment " C7337219.gif " deleted by S Chaney/Surgery/UNMC/UNEBR] [attachment " C9501336.gif " deleted by S Chaney/Surgery/UNMC/UNEBR]

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Thanksguys! From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of SChaneySent: Friday, January 15, 2010 9:09 AMTo: TxFinancialCoordinators Subject: Re: PRESCRIPTION COVERAGE Ourprocess is a little different. We have pharmacy financial counselors. Weinitially call the pharmacy help desk for that plan to obtain the copaystructure. Sometimes the help desk is more beneficial in finding out the truthabout the copay structure, sometimes they are not. If they are not helpful,then we try the medical aspect of the plan. Initially, we ask for the copay structure. Example: Generics $5,Preferred brands $25, Non-preferred brands $50 for a 30 day supply at aretail pharmacy. Then if there is a mail order option with saving benefit andwho that is through and what that structure is. Always ask if there is anannual deductible or out of pocket max/cap benefit for prescription meds.Some plans, especially if you’re talking to the medical side, get confused andwill tell you the medical deductible/out of pocket. It is also beneficial toask where the pt is at in regards to those figures. At that point, we hit the key meds: Prograf, Cellcept, andValcyte. A plan 95% of the time can tell you what the copay for thosemedications are. Our standard is Prograf 1mg caps, 5mg twice daily: ie 300 capsfor a 30 day supply; Cellcept 250mg, 1000mg twice daily (240/30), Valcyte450mg, 900 mg daily. At this point, the representative can either run a testclaim and tell you the copay, or check the insurance drug formulary list andtell you where those meds fall. Since there is not a generic available forValcyte, it is always a Brand, Non-formulary brand or Specialty medication.Since Prograf and Cellcept now have generics available, it is essential to askif there is a penalty or auxiliary fee for the pt to receive the brand versionof the medication versus the generic and if the doctor writing DAW (dispense aswritten) affects that copay/penalty fee. The fee is typically the cashdifference between the cost of the generic medication and brand medication,which for Cellcept turns out to be between a $600-$900 difference. Since we’recalling from the pharmacy end, we also ask if those medications require a priorauthorization or need to be filled at a specialty pharmacy to help ease ourdischarges post transplant. For added information, knowing if the policy is a mandatorygeneric policy or mandatory mail order for maintenance meds is beneficial forthe patient. The majority of the remaining medications on our protocol easilyfit into the copay structure. Colace would be either over the counter orgeneric (which may or may not be covered but is fairly inexpensive. Bactrim isa generic and would be the generic copay and so on and so forth. That is a quick rundown of our process. I’d always be more happyto go into more detail if necessary and feel free to contact me with questions.Best of luck!! Jennie Gollehon PharmacyFinancial Counselor Phone: Email:jgollehon@... NebraskaMedical Center, Omaha, Nebraska From: S Chaney Sent: Friday, January 15, 2010 8:42 AMTo: Gollehon, Jennie ASubject: Fw: PRESCRIPTION COVERAGE is this how it's done ? ----- Forwarded by S Chaney/Surgery/UNMC/UNEBR on 01/15/2010 08:42 AM----- To: <TxFinancialCoordinators >Date: 01/15/201008:07 AM Subject: Re: PRESCRIPTION COVERAGE Sent by: TxFinancialCoordinators Dear Melisa,We generally call the Insurance Company, and ask for the RX coverage plans, andlook through the different tiers for what is, and is not covered brand, andgeneric.The patient is then advised from there.Thanks,DorindaDorinda S. Frye, ARC RepDFrye@...Hematology/Oncology AkronHematology/Oncology Mahoning ValleyInfusion TherapyCraniofacial Office FaxTrammell Melisa Trammell Melisa Sent by: <TxFinancialCoordinators > 01/15/2010 08:59 AM Please respond to<TxFinancialCoordinators > To " TxFinancialCoordinators " <TxFinancialCoordinators >ccSubject PRESCRIPTION COVERAGE Goodmorning! I am going to start obtaining the prescription coverage in my office.Prograf, Myfortic, Bactrim, Colace, Mycelex, and Valcyte are the common meds.How do you know which Meds are which tiers and we don’t know which dosage isgoing to be prescribed, so how do you give the patient an idea of what thecosts are? What questions do you ask? Is there a general way to go about this?MissyTrammell- TransplantFinancial Coordinator ResearchMedical Center 6400Prospect, Ste 328 KansasCity, MO 64132 phone fax melisa.trammell@... ------------------------------------------------------------------------- This message was secured by ZixCorp®. The Nebraska Medical Center E-mail Confidentiality DisclaimerThe information in this e-mail may be privileged and confidential, intendedonly for the use of the addressee(s) above. Any unauthorized use or disclosure ofthis information is prohibited. If you have received this e-mail by mistake,please delete it and immediately contact the sender. To: <TxFinancialCoordinators >Date: 01/15/201008:49 AM Subject: Re: PRESCRIPTION COVERAGE Sent by: TxFinancialCoordinators When we are asked about Rx coverage, we can assist with theinformation only, and refer them to their Insurance and if need be show themhow to read the tiers if they have a tier plan Rx. We have had patients whoneed prior auth for Rx and yes we do do that if it is related to services andcare.Does anyone else do something different?Dorinda S. Frye, ARC RepDFrye@...Hematology/Oncology AkronHematology/Oncology Mahoning ValleyInfusion TherapyCraniofacial Office FaxS Chaney Sent by: <TxFinancialCoordinators > 01/15/2010 09:39 AM Please respond to<TxFinancialCoordinators > To<TxFinancialCoordinators > ccSubjectRe: PRESCRIPTION COVERAGE is this how it's done ? To: <TxFinancialCoordinators > Date: 01/15/2010 08:07 AM Subject: Re: PRESCRIPTION COVERAGE Sent by: TxFinancialCoordinators Dear Melisa,We generally call the Insurance Company, and ask for the RX coverage plans, andlook through the different tiers for what is, and is not covered brand, andgeneric.The patient is then advised from there.Thanks,DorindaDorinda S. Frye, ARC RepDFrye@...Hematology/Oncology AkronHematology/Oncology Mahoning ValleyInfusion TherapyCraniofacial Office FaxTrammell Melisa Trammell Melisa Sent by: <TxFinancialCoordinators > 01/15/2010 08:59 AM Please respond to<TxFinancialCoordinators > To " TxFinancialCoordinators " <TxFinancialCoordinators > cc Subject PRESCRIPTION COVERAGE Goodmorning! I am going to start obtaining the prescription coverage in my office.Prograf, Myfortic, Bactrim, Colace, Mycelex, and Valcyte are the common meds.How do you know which Meds are which tiers and we don’t know which dosage isgoing to be prescribed, so how do you give the patient an idea of what thecosts are? What questions do you ask? Is there a general way to go about this? MissyTrammell- TransplantFinancial Coordinator ResearchMedical Center 6400Prospect, Ste 328 KansasCity, MO 64132 phone fax melisa.trammell@... [attachment " pic21881.gif " deleted by S Chaney/Surgery/UNMC/UNEBR][attachment " C0845245.gif " deleted by S Chaney/Surgery/UNMC/UNEBR][attachment " C5115995.gif " deleted by S Chaney/Surgery/UNMC/UNEBR][attachment " pic13966.gif " deleted by S Chaney/Surgery/UNMC/UNEBR][attachment " C7337219.gif " deleted by S Chaney/Surgery/UNMC/UNEBR][attachment " C9501336.gif " deleted by S Chaney/Surgery/UNMC/UNEBR]