Tier3DefaultDuration(12/31/13)FDA-approvedfor thediagnosis*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 yearTier-CostGridNoTIERXPARequiredor BvsDNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLEditTeamSharedVerbiageThe AppealsandGrievanceDepartmentAddress60DaysCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupOneTouchandAccucheckBrandTransitionalOverrideGenericYesContinuationof therapyLowestpossibletier"Good"diagnosis(FDA-approvedOR approvableoff-label)Drugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsTier2Tier3DefaultDuration(12/31/13)FDA-approvedfor thediagnosis*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 yearTier-CostGridNoTIERXPARequiredor BvsDNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLEditTeamSharedVerbiageThe AppealsandGrievanceDepartmentAddress60DaysCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupOneTouchandAccucheckBrandTransitionalOverrideGenericYesContinuationof therapyLowestpossibletier"Good"diagnosis(FDA-approvedOR approvableoff-label)Drugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsTier2

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.


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