Tier-CostGrid60DaysYesTransitionalOverrideTIERXThe AppealsandGrievanceDepartmentAddressFDA-approvedfor thediagnosisSharedVerbiageTier3OneTouchandAccucheckTier2DefaultDuration(12/31/13)LowestpossibletierContinuationof therapyNoGenericBrand"Good"diagnosis(FDA-approvedOR approvableoff-label)NF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsEditTeamPARequiredor BvsD*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-CostGrid60DaysYesTransitionalOverrideTIERXThe AppealsandGrievanceDepartmentAddressFDA-approvedfor thediagnosisSharedVerbiageTier3OneTouchandAccucheckTier2DefaultDuration(12/31/13)LowestpossibletierContinuationof therapyNoGenericBrand"Good"diagnosis(FDA-approvedOR approvableoff-label)NF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsEditTeamPARequiredor BvsD*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

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