Continuationof therapyFDA-approvedfor thediagnosisOneTouchandAccucheckDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsSharedVerbiageNoBrand*Level of care change atanytime during eligibility,*New member or haschanged plans in the last90 days, *Currentmember affected byformulary change and isin the first 90 days of newcontract yearTIERXThe AppealsandGrievanceDepartmentAddress60DaysGenericNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLYesTier3EditTeamTier2Tier-CostGridPARequiredor BvsDTransitionalOverrideDefaultDuration(12/31/13)"Good"diagnosis(FDA-approvedOR approvableoff-label)LowestpossibletierCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupContinuationof therapyFDA-approvedfor thediagnosisOneTouchandAccucheckDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsSharedVerbiageNoBrand*Level of care change atanytime during eligibility,*New member or haschanged plans in the last90 days, *Currentmember affected byformulary change and isin the first 90 days of newcontract yearTIERXThe AppealsandGrievanceDepartmentAddress60DaysGenericNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLYesTier3EditTeamTier2Tier-CostGridPARequiredor BvsDTransitionalOverrideDefaultDuration(12/31/13)"Good"diagnosis(FDA-approvedOR approvableoff-label)LowestpossibletierCome up withalternativesourselves usingclinicalpharmacology andFormulary Lookup

TCSE/T.O./Americhoice Unison/Appeals/Brand vs Generic - Call List

(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.


1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
  1. Continuation of therapy
  2. FDA-approved for the diagnosis
  3. One Touch and Accucheck
  4. Drugs on specialty tier, Non-Formulary, Compounds, Tier 1, Part B medications
  5. Shared Verbiage
  6. No
  7. Brand
  8. *Level of care change at anytime during eligibility, *New member or has changed plans in the last 90 days, *Current member affected by formulary change and is in the first 90 days of new contract year
  9. TIERX
  10. The Appeals and Grievance Department Address
  11. 60 Days
  12. Generic
  13. NF, PA required, BvsD for immuno-suppressants (transplant meds only), QL
  14. Yes
  15. Tier 3
  16. Edit Team
  17. Tier 2
  18. Tier-Cost Grid
  19. PA Required or BvsD
  20. Transitional Override
  21. Default Duration (12/31/13)
  22. "Good" diagnosis (FDA-approved OR approvable off-label)
  23. Lowest possible tier
  24. Come up with alternatives ourselves using clinical pharmacology and Formulary Lookup