FDA-approvedfor thediagnosisTier3Drugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsBrandGenericDefaultDuration(12/31/13)Tier2*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 yearSharedVerbiageEditTeamTier-CostGridTransitionalOverridePARequiredor BvsD60DaysCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupContinuationof therapyTIERXThe AppealsandGrievanceDepartmentAddressNo"Good"diagnosis(FDA-approvedOR approvableoff-label)OneTouchandAccucheckLowestpossibletierYesNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QLFDA-approvedfor thediagnosisTier3Drugs onspecialty tier,Non-Formulary,Compounds,Tier 1, Part BmedicationsBrandGenericDefaultDuration(12/31/13)Tier2*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 yearSharedVerbiageEditTeamTier-CostGridTransitionalOverridePARequiredor BvsD60DaysCome up withalternativesourselves usingclinicalpharmacology andFormulary LookupContinuationof therapyTIERXThe AppealsandGrievanceDepartmentAddressNo"Good"diagnosis(FDA-approvedOR approvableoff-label)OneTouchandAccucheckLowestpossibletierYesNF, PArequired, BvsDfor immuno-suppressants(transplantmeds only), QL

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