Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 We have certain pharmacies we work with to ensure we use an in network pharmacy for our patients.I fax a list of potential medications to the pharm at time the patient is called in and have an accurate cost list for the patient before they receive the medications. Amellia Gay and WhiteTemple TX>>> "Jelali, Tamara" 11/16/2011 6:37 AM >>> I was hoping someone would share with me their approach to getting a pharmacy summary from the patients pharmacy vendor when requesting pricing on medications, precerts, authorization, in network pharmacies, specialty pharmacy information, etc. Currently we have an agreement w/ a particular pharmacy to obtain our medications for patients prior to d/c however we have been running into increased out of pocket expense for the patients due to misinformation from the pharmacy vendor when obtaining the initial information on the patients plan.Thank you,Tamara JelaliFinancial CoordinatorKidney/Pancreas and Peds Small Bowel/Livertown University HospitalWashington, DC 20007(P) (F) CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 We have certain pharmacies we work with to ensure we use an in network pharmacy for our patients.I fax a list of potential medications to the pharm at time the patient is called in and have an accurate cost list for the patient before they receive the medications. Amellia Gay and WhiteTemple TX>>> "Jelali, Tamara" 11/16/2011 6:37 AM >>> I was hoping someone would share with me their approach to getting a pharmacy summary from the patients pharmacy vendor when requesting pricing on medications, precerts, authorization, in network pharmacies, specialty pharmacy information, etc. Currently we have an agreement w/ a particular pharmacy to obtain our medications for patients prior to d/c however we have been running into increased out of pocket expense for the patients due to misinformation from the pharmacy vendor when obtaining the initial information on the patients plan.Thank you,Tamara JelaliFinancial CoordinatorKidney/Pancreas and Peds Small Bowel/Livertown University HospitalWashington, DC 20007(P) (F) CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 Amelia,Are you getting prices on just the potential immunos, or all of their potential meds? M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Amellia GaySent: Wednesday, November 16, 2011 10:51 AMTo: TxFinancialCoordinators@Subject: Re: Pharmacy Question We have certain pharmacies we work with to ensure we use an in network pharmacy for our patients.I fax a list of potential medications to the pharm at time the patient is called in and have an accurate cost list for the patient before they receive the medications. Amellia Gay and WhiteTemple TX>>> " Jelali, Tamara " 11/16/2011 6:37 AM >>> I was hoping someone would share with me their approach to getting a pharmacy summary from the patients pharmacy vendor when requesting pricing on medications, precerts, authorization, in network pharmacies, specialty pharmacy information, etc. Currently we have an agreement w/ a particular pharmacy to obtain our medications for patients prior to d/c however we have been running into increased out of pocket expense for the patients due to misinformation from the pharmacy vendor when obtaining the initial information on the patients plan.Thank you,Tamara JelaliFinancial CoordinatorKidney/Pancreas and Peds Small Bowel/Livertown University HospitalWashington, DC 20007(P) (F) CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 On all the potential meds. I send a list of about 16 key drugs that I have had issues with in the past.They run a "dummy claim" and let me know what the actual copay would be on each.>>> 11/16/2011 10:44 AM >>> Amelia,Are you getting prices on just the potential immunos, or all of their potential meds? M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Amellia GaySent: Wednesday, November 16, 2011 10:51 AMTo: TxFinancialCoordinators@Subject: Re: Pharmacy QuestionWe have certain pharmacies we work with to ensure we use an in network pharmacy for our patients.I fax a list of potential medications to the pharm at time the patient is called in and have an accurate cost list for the patient before they receive the medications.Amellia Gay and WhiteTemple TX>>> "Jelali, Tamara" 11/16/2011 6:37 AM >>> I was hoping someone would share with me their approach to getting a pharmacy summary from the patients pharmacy vendor when requesting pricing on medications, precerts, authorization, in network pharmacies, specialty pharmacy information, etc. Currently we have an agreement w/ a particular pharmacy to obtain our medications for patients prior to d/c however we have been running into increased out of pocket expense for the patients due to misinformation from the pharmacy vendor when obtaining the initial information on the patients plan.Thank you,Tamara JelaliFinancial CoordinatorKidney/Pancreas and Peds Small Bowel/Livertown University HospitalWashington, DC 20007(P) (F) CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 On all the potential meds. I send a list of about 16 key drugs that I have had issues with in the past.They run a "dummy claim" and let me know what the actual copay would be on each.>>> 11/16/2011 10:44 AM >>> Amelia,Are you getting prices on just the potential immunos, or all of their potential meds? M. Christiansen, BAS, RNTransplant Financial Case Manager DeVos Heart and Lung Transplant Program100 Michigan NEMC 231Grand Rapids, MI 49503Phone: Pager: Fax: lisa.christiansen@... From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Amellia GaySent: Wednesday, November 16, 2011 10:51 AMTo: TxFinancialCoordinators@Subject: Re: Pharmacy QuestionWe have certain pharmacies we work with to ensure we use an in network pharmacy for our patients.I fax a list of potential medications to the pharm at time the patient is called in and have an accurate cost list for the patient before they receive the medications.Amellia Gay and WhiteTemple TX>>> "Jelali, Tamara" 11/16/2011 6:37 AM >>> I was hoping someone would share with me their approach to getting a pharmacy summary from the patients pharmacy vendor when requesting pricing on medications, precerts, authorization, in network pharmacies, specialty pharmacy information, etc. Currently we have an agreement w/ a particular pharmacy to obtain our medications for patients prior to d/c however we have been running into increased out of pocket expense for the patients due to misinformation from the pharmacy vendor when obtaining the initial information on the patients plan.Thank you,Tamara JelaliFinancial CoordinatorKidney/Pancreas and Peds Small Bowel/Livertown University HospitalWashington, DC 20007(P) (F) CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 We verify the three major or most likely to be used medications Prograf, Cellcept and Valcyte on all transplant patients, on Lung we include VFend and on BMT we include Neupogen on Hep C patient we include the medications below; if the medication requires authorization we request authorization forms scan it to patients file and it is there when patient is called in for transplant for physician to complete and fax back. We have several transplant teams (Heart/Lung; Kidney/Pancreas; Liver/Small Bowel and BMT) this way fits most of our teams. Once we finish the Pharmacy verification we review and send the patient the attached letter prior to the Evaluation if their co-pays are expensive or we feel patient may need assistance. All of this is done Prior to the evaluation because if the patient can’t afford the Medications and don’t take them the transplant will surely reject. ........ PATIENT ALSO HAS $2,500.00 YEARLY OUT/POCKET TOO ($16.20 MET) RETAIL: GENERIC $6.00; BRAND $38.00; NON FORMULARY $80.00 X 30/DAYS MAIL: GENERIC $6.00; BRAND $38.00; NON FORMULARY $80.00 X 90/DAYS ..... NON FORMULARY MEDICATION WILL BE $80.00 OR 20% DEPENDING ON IF ..... IT IS A TIER III OR TIER IV MEDICATION. PROGRAF/TACROLIMUS 5MG 60/CAP X 30/DAYS= $ 80.00 COPAY W/AUTH 800 555-2546 CELLCEPT 500MG 60/CAP X 30/DAYS= $ 21.82 COPAY W/AUTH 800 555-2546 VALCYTE 450MG 60/CAP X 30/DAYS= $165.00 COPAY NO AUTH REQUIRED PROCRIT 40,000 UNIT 1/WK X 30/DAYS ( 4)= $550.68 COPAY (20%) W/AUTH ... NEUPOGEN 300MCG 3/WK X 30/DAYS (12)= $607.09 COPAY (20%) W/AUTH .... PEGASYS 180MCG 1/WK X 30/DAYS ( 4)= $1,950.54 COPAY (20%) W/AUTH ... RIBAVIRIN 200MG 6/DAY X 30/DAYS(180)= $ 38.00 COPAY W/AUTH 800 555-2546 .. TELAPREVIR 375MG 6/DAY X 30/DAYS(180)= $5,653.61 (INCIVEK) W/AUTH Thank You, Beverly mailto:Bmitchell@... Reagan - UCLA Hospital Supervisor Transplant Financial Coordinator Telephone# Fax # PLEASE NOTE: This e-mail (and any attachments) is only intended for the use of the person or entity to which it is addressed and contains information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized re-disclosure or failure to maintain confidentiality could subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by telephone or return email and delete this message from your computer. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Amellia Gay Sent: Wednesday, November 16, 2011 7:51 AM To: TxFinancialCoordinators Subject: Re: Pharmacy Question We have certain pharmacies we work with to ensure we use an in network pharmacy for our patients. I fax a list of potential medications to the pharm at time the patient is called in and have an accurate cost list for the patient before they receive the medications. Amellia Gay and White Temple TX >>> " Jelali, Tamara " 11/16/2011 6:37 AM >>> I was hoping someone would share with me their approach to getting a pharmacy summary from the patients pharmacy vendor when requesting pricing on medications, precerts, authorization, in network pharmacies, specialty pharmacy information, etc. Currently we have an agreement w/ a particular pharmacy to obtain our medications for patients prior to d/c however we have been running into increased out of pocket expense for the patients due to misinformation from the pharmacy vendor when obtaining the initial information on the patients plan. Thank you, Tamara Jelali Financial Coordinator Kidney/Pancreas and Peds Small Bowel/Liver town University Hospital Washington, DC 20007 (P) (F) CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you. IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by return email, and delete this message from your computer. 1 of 1 File(s) RX Explanation of Liability letter.doc Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2011 Report Share Posted November 16, 2011 We verify the three major or most likely to be used medications Prograf, Cellcept and Valcyte on all transplant patients, on Lung we include VFend and on BMT we include Neupogen on Hep C patient we include the medications below; if the medication requires authorization we request authorization forms scan it to patients file and it is there when patient is called in for transplant for physician to complete and fax back. We have several transplant teams (Heart/Lung; Kidney/Pancreas; Liver/Small Bowel and BMT) this way fits most of our teams. Once we finish the Pharmacy verification we review and send the patient the attached letter prior to the Evaluation if their co-pays are expensive or we feel patient may need assistance. All of this is done Prior to the evaluation because if the patient can’t afford the Medications and don’t take them the transplant will surely reject. ........ PATIENT ALSO HAS $2,500.00 YEARLY OUT/POCKET TOO ($16.20 MET) RETAIL: GENERIC $6.00; BRAND $38.00; NON FORMULARY $80.00 X 30/DAYS MAIL: GENERIC $6.00; BRAND $38.00; NON FORMULARY $80.00 X 90/DAYS ..... NON FORMULARY MEDICATION WILL BE $80.00 OR 20% DEPENDING ON IF ..... IT IS A TIER III OR TIER IV MEDICATION. PROGRAF/TACROLIMUS 5MG 60/CAP X 30/DAYS= $ 80.00 COPAY W/AUTH 800 555-2546 CELLCEPT 500MG 60/CAP X 30/DAYS= $ 21.82 COPAY W/AUTH 800 555-2546 VALCYTE 450MG 60/CAP X 30/DAYS= $165.00 COPAY NO AUTH REQUIRED PROCRIT 40,000 UNIT 1/WK X 30/DAYS ( 4)= $550.68 COPAY (20%) W/AUTH ... NEUPOGEN 300MCG 3/WK X 30/DAYS (12)= $607.09 COPAY (20%) W/AUTH .... PEGASYS 180MCG 1/WK X 30/DAYS ( 4)= $1,950.54 COPAY (20%) W/AUTH ... RIBAVIRIN 200MG 6/DAY X 30/DAYS(180)= $ 38.00 COPAY W/AUTH 800 555-2546 .. TELAPREVIR 375MG 6/DAY X 30/DAYS(180)= $5,653.61 (INCIVEK) W/AUTH Thank You, Beverly mailto:Bmitchell@... Reagan - UCLA Hospital Supervisor Transplant Financial Coordinator Telephone# Fax # PLEASE NOTE: This e-mail (and any attachments) is only intended for the use of the person or entity to which it is addressed and contains information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized re-disclosure or failure to maintain confidentiality could subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by telephone or return email and delete this message from your computer. From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Amellia Gay Sent: Wednesday, November 16, 2011 7:51 AM To: TxFinancialCoordinators Subject: Re: Pharmacy Question We have certain pharmacies we work with to ensure we use an in network pharmacy for our patients. I fax a list of potential medications to the pharm at time the patient is called in and have an accurate cost list for the patient before they receive the medications. Amellia Gay and White Temple TX >>> " Jelali, Tamara " 11/16/2011 6:37 AM >>> I was hoping someone would share with me their approach to getting a pharmacy summary from the patients pharmacy vendor when requesting pricing on medications, precerts, authorization, in network pharmacies, specialty pharmacy information, etc. Currently we have an agreement w/ a particular pharmacy to obtain our medications for patients prior to d/c however we have been running into increased out of pocket expense for the patients due to misinformation from the pharmacy vendor when obtaining the initial information on the patients plan. Thank you, Tamara Jelali Financial Coordinator Kidney/Pancreas and Peds Small Bowel/Liver town University Hospital Washington, DC 20007 (P) (F) CONFIDENTIAL: The information contained in this communication, including its attachments may contain confidential information and is intended only for the individual (s) or entity (ies) to whom it is addressed . The information contained in this communication may also be protected by legal privilege , federal law or other applicable law. If you are not the intended recipient of this communication , you are hereby notified that any distribution, dissemination or duplication of this communication is strictly prohibited. If you have received this communication in error please immediately delete and destroy all copies of this message and please immediately notify us of the error by separate communication . Thank you. IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by return email, and delete this message from your computer. 1 of 1 File(s) RX Explanation of Liability letter.doc Quote Link to comment Share on other sites More sharing options...
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