Accessing HCV medications

Pathways for HCV Medications In order of priority of use: Medicare Part D Private Insurance Medicaid Patient assistance programs

Insurance Requirements These vary by type of insurance Always get a copy of the card Often times an individual who has Medicare A & B actually has part D also, but is not aware of it. You may have to probe a bit to determine if they do. Prior Authorization is usually required Should be a phone number to call on card. Their forms may be found on their website. If unsure, call their number and they will send it to you or tell you where to find it online. Some require a specialty pharmacy, some do not. It’s always good to ask, especially if you have the ability to fill on-site.

Oklahoma Medicaid Medicaid has several forms to fill out. Link for forms: http://www.okhca.org/providers.aspx?id=16000 You will find the most up to date forms as well as the preferred drugs for each genotype. They will now approve fibrosis scores F-0 to F-4 Forms are: Intent to Treat Drug Specific Initiation Prior Authorization Form Pharmacy Agreement Continuation of treatment Prior authorization Form

Patient Assistance Program Gilead Sofosbuvir sofosbuvir/velpatasvir sofosbuvir/velpatasvir/voxilaprevir Abbvie glecaprevir/pivrentasvir

Gilead Link for PAP Application www.mysupport path.com/…Support_Path_ Intake_ Form.pdf Phone number to check on application if they don’t respond in a week: 855-769-7284. Be prepared to provide them with patient’s name, dob, address, zip, and phone. General Hints/Tips for filling out the application Household size Income (all household) Residency Notarized statement Native American status . Must document income for all “household members” who contribute to the household income, file taxes with the patient (or would if the patient filed taxes). Documentation can be the last 2 paystubs for each member, last year’s income tax form or a notarized statement specifying what each person makes. This can include children or other dependent relatives who are not included on the income tax form. People sharing the home are not considered household members. Documentation of residence, in the form of picture ID or utility bill in the patient’s name. This information can also be included in the notarized statement and will count as the necessary documentation. If the patient has a PO box, an address MUST be provided and documented. The notarized statement can work well here, just state the patient’s mailing address is different than their finding address and list both. Be sure and indicate the patient does not have insurance. Draw a line across the page where it asks for other insurance information and write “Exempt/Native American.” Either include this in the notarized statement or make sure to include a copy of the CDIB or tribe card with the PAP application. You may be asked if the patient receives services from IHS. If your tribe provides care, they will approve the application. If it is an IHS facility, it could be a problem but an argument could be made that these meds are not provided by IHS. Wait for them to call you to inquire, rather than giving the information up front. They will call if they want to know. Feel free to call if you have this problem and I will tell you what worked for me on a similar issue. Abbvie: Same as for Gilead except a copy of CDIB/Tribe membership MUST be included.

Abbvie Link for PAP Application is unavailable. Call 1- 855-867-7503 and they will fax you a copy. General Hints/Tips for filling out the application: Refer to the tips for Gilead which are in the notes section. The only difference is that they require a copy of CDIB/Tribe card.

Core principles of case management Link – to connect to available resources Advocate – to be the voice for another Refer –to provide information for additional resources

Necessary skills Creativity Commitment Patience Organizational abilities Ability to assert oneself

Challenges Time limitations Knowledge deficiencies Limited resources Losing patients to follow up

Solutions Learn payor sources Organize according to what works for you Cheat sheets can be your best friend Create relationships

More solutions Talk with others Ask for help Be assertive (especially with payor sources) Be open to new ideas Practice patience

Losing patients to follow up Remember the goal Commit to find people and be creative in the process Explore the barriers preventing follow-through Keep in mind not everyone is ready for treatment

Keep in mind Who’s responsibility is it really? Be patient with the pace of others Know you’re not alone

Final thoughts When you are ready to give up, remember why you started in the first place!