TIERXTier-CostGridFDA-approvedfor thediagnosisThe AppealsandGrievanceDepartmentAddressSharedVerbiageEditTeamGenericOneTouchandAccucheckNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part Bmedications60DaysTier2YesTier3PARequiredor BvsD"Good"diagnosis(FDA-approvedOR approvableoff-label)DefaultDuration(12/31/13)Continuationof therapyLowestpossibletierTransitionalOverride*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 yearCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupNoBrandTIERXTier-CostGridFDA-approvedfor thediagnosisThe AppealsandGrievanceDepartmentAddressSharedVerbiageEditTeamGenericOneTouchandAccucheckNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part Bmedications60DaysTier2YesTier3PARequiredor BvsD"Good"diagnosis(FDA-approvedOR approvableoff-label)DefaultDuration(12/31/13)Continuationof therapyLowestpossibletierTransitionalOverride*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 yearCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupNoBrand

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