Continuationof therapyDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part Bmedications*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 yearBrandOneTouchandAccucheckGenericCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupEditTeamYesTIERXThe AppealsandGrievanceDepartmentAddressNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLSharedVerbiageDefaultDuration(12/31/13)Tier2Tier3"Good"diagnosis(FDA-approvedOR approvableoff-label)60DaysLowestpossibletierTransitionalOverrideTier-CostGridNoPARequiredor BvsDFDA-approvedfor thediagnosisContinuationof therapyDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part Bmedications*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 yearBrandOneTouchandAccucheckGenericCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupEditTeamYesTIERXThe AppealsandGrievanceDepartmentAddressNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLSharedVerbiageDefaultDuration(12/31/13)Tier2Tier3"Good"diagnosis(FDA-approvedOR approvableoff-label)60DaysLowestpossibletierTransitionalOverrideTier-CostGridNoPARequiredor BvsDFDA-approvedfor thediagnosis

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