Tier2NoContinuationof therapyTier-CostGridNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLOneTouchandAccucheckDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsTransitionalOverride60Days*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 yearPARequiredor BvsDThe AppealsandGrievanceDepartmentAddressBrandTier3EditTeamGenericTIERXLowestpossibletierCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupSharedVerbiageFDA-approvedfor thediagnosisDefaultDuration(12/31/13)Yes"Good"diagnosis(FDA-approvedOR approvableoff-label)Tier2NoContinuationof therapyTier-CostGridNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLOneTouchandAccucheckDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsTransitionalOverride60Days*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 yearPARequiredor BvsDThe AppealsandGrievanceDepartmentAddressBrandTier3EditTeamGenericTIERXLowestpossibletierCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupSharedVerbiageFDA-approvedfor thediagnosisDefaultDuration(12/31/13)Yes"Good"diagnosis(FDA-approvedOR approvableoff-label)

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