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Enrollment/EMR
How does text enrollment work?
How will PhilRx Pharmacy appear on EMR?
If offices have issues with EMR, is there a service to contact for the help?
Does PhilRx have a direct contact Line for EMR issues?
Does the provider enter the patient's email address onto the EHR? If not, where?
For the text messages to start, does the provider input the patient cell number into EHR?
What happens if a patient does not want to receive text and not share their number? What is the phone number on file is a landline and not a mobile number?
Won’t the patients ignore these text messages as spam?
My HCP will not input insurance details when sending to a new HUB therefore in order to even start the process, will Phil not need to contact the patient for this info?
What if the patient does not want text nor emails and only wants to communicate via Phone? How does the provider initiate this action?
General Communications
What means of communication does PhilRx use? Phone? Email? Text?
General customer service support? Is there a live service to contact?
How can PhilRx support additional language needs?
What is the process for a patient that does not speak English?
What is the process for a staff member that speaks limited English?
What languages do we offer support?
If a patient needs to be contacted by text or call in a different language, how is this facilitated?
Pharmacy Network
Which pharmacies does the actual Rx fill?
Can the patient pick up their prescription from a Phil partner pharmacy in person?
Can the patient pick a pharmacy that is not part of the Phil network?
Patient Experience
What is the refill process and procedure? Is PhilRx contacting patients when refills are sent or are they just automatically fulfilled with no notification?
Does the patient text program provide any additional services besides enrollment? IE - adherence, reminders, tips, etc.
When the script has no more refills, does PhilRx contact the office to get a new script?
Does PhilRx accept any "transfers" of refills from other pharmacies?
Does PhilRx fill non program scripts?
In what timeframe will Phil contact the patient?
What is the SOP for patients not opening or responding to the text messages? Will PhilRX call the patient?
When will PhilRx contact the office about a patient who does respond to our messages?
How long does it take for the Rx get to the patient?
Once a Pharmacy receives the order, does the Pharmacy have a timeframe to get it out the door?
If a patient has challenges receiving mail, is there another means to receive their prescription?
Are refills triggered by the Hub or Pharmacy?
Prior Authorizations
Will PhilRx complete the PA process? If so, how long? What is the staff's role?
Who is initiating the PA process? Pharmacist? PhilRx? Office?
PhilRx reviews all documents submitted during the initial Rx submission, assuming this is done prior to the initial submission to payor?
If the provider/staff includes documentation for the PA/SE in the notes section of initial submission, will Phil then input into CMM for them or will they still need to do it themselves (key code & notes)?
What if the HCP/office prefers to do their own PA?
What is the process if/when additional medical documents are needed for step edits?
If additional documentation is needed from the provider's office, how will PhilRx communicate with the provider? Fax? Phone? Email? Portal? How many days goes by before PhilRx tries an alternate method or general reminder?
Is there an HCP Portal available?
PA process and documentation submission is done through CoverMyMeds™ (CMM). What if the office does not use CMM? Any alternate methods?
Does PhilRx have a turnaround time frame to final review and approve everything after the provider submits everything accurately? Within the day? 24 hr? 48 hr?
Let’s say the PA process is complete and it is determined that the patient hasn't met the steps needed. Will PhilRx fill this rx requirement and ship to patient or does patient fill in a traditional manner?
How does PhilRx help manage step therapy that requires a specific duration? Will PhilRx follow up with patients after 2 months of the step therapy? Will they fill the step therapy?
What does the appeal process look like for patients that get a denial, does the office need to request appeal or is automatically processed?
How can PhilRx nationally support tough plans like XYZ for a specific indication?
Copays/eBV
Will patient’s out of pocket cost be strictly the copay? Shipping cost?
After determining benefits investigation and applying copay program (if eligible), does the PhilRx Hub apply any other state/privately funded programs to aid with payment? Including LIS?
Is Copay buydown automatically applied? What if copay needs to be “activated”?
Payments/Shipping
With initial fill, assuming the patient will determine the final OOP determined by the eBV to determine final cost? Are debit/credit cards accepted? Apple Pay? Venmo? Paypal?
When refills are completed, does the patient have to input payment every time? Are credit/debit cards saved? Does the system allow patients to switch credit/debit cards?
Does the patient input the shipping address during the initial Rx? Can this address be modified for subsequent refills? How?
Will the provider get any notification that Rx has been successfully filled?
How long does it take for an order to process?
Portal and Provider Questions
Why or why not should HCPs request/use the HCP Portal?
Can offices have step by step instructions?
For multi-physician practices, does the portal include the entire group and individual doctors?
Can office customize portal during initial welcome call with champion?
Client/Rep Communications
What visibility will TMs and DMs have during this program?
Can our TM compliantly discuss “PhilRx”?
Data Capture
How will the data be captured? Pharmacies report to IQVIA?
Marketing and Branded Documents
Is there a program-specific branded documentation/sheet?
