Continuationof therapyDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsSharedVerbiageDefaultDuration(12/31/13)FDA-approvedfor thediagnosisLowestpossibletierBrand*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 yearEditTeamThe AppealsandGrievanceDepartmentAddressGenericNoOneTouchandAccucheckYesTier360DaysCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupTier-CostGridPARequiredor BvsD"Good"diagnosis(FDA-approvedOR approvableoff-label)TransitionalOverrideTier2NF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLTIERXContinuationof therapyDrugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsSharedVerbiageDefaultDuration(12/31/13)FDA-approvedfor thediagnosisLowestpossibletierBrand*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 yearEditTeamThe AppealsandGrievanceDepartmentAddressGenericNoOneTouchandAccucheckYesTier360DaysCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupTier-CostGridPARequiredor BvsD"Good"diagnosis(FDA-approvedOR approvableoff-label)TransitionalOverrideTier2NF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLTIERX

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