60DaysOneTouchandAccucheckTIERXCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupFDA-approvedfor thediagnosisDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsBrandPARequiredor BvsDTier3TransitionalOverrideEditTeamGenericNo"Good"diagnosis(FDA-approvedOR approvableoff-label)LowestpossibletierTier-CostGridTier2Continuationof therapy*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 yearThe AppealsandGrievanceDepartmentAddressYesNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLDefaultDuration(12/31/13)SharedVerbiage60DaysOneTouchandAccucheckTIERXCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupFDA-approvedfor thediagnosisDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsBrandPARequiredor BvsDTier3TransitionalOverrideEditTeamGenericNo"Good"diagnosis(FDA-approvedOR approvableoff-label)LowestpossibletierTier-CostGridTier2Continuationof therapy*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 yearThe AppealsandGrievanceDepartmentAddressYesNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLDefaultDuration(12/31/13)SharedVerbiage

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