FDA-approvedfor thediagnosisYesLowestpossibletierTransitionalOverrideDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsGenericBrandSharedVerbiagePARequiredor BvsDContinuationof therapyCome up withalternativesourselves usingclinicalpharmacology andFormulary Lookup60DaysDefaultDuration(12/31/13)Tier2TIERX*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 year"Good"diagnosis(FDA-approvedOR approvableoff-label)The AppealsandGrievanceDepartmentAddressTier-CostGridEditTeamOneTouchandAccucheckTier3NF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLNoFDA-approvedfor thediagnosisYesLowestpossibletierTransitionalOverrideDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsGenericBrandSharedVerbiagePARequiredor BvsDContinuationof therapyCome up withalternativesourselves usingclinicalpharmacology andFormulary Lookup60DaysDefaultDuration(12/31/13)Tier2TIERX*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 year"Good"diagnosis(FDA-approvedOR approvableoff-label)The AppealsandGrievanceDepartmentAddressTier-CostGridEditTeamOneTouchandAccucheckTier3NF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLNo

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