| All About Amgen | All About RA and Derm | All About ODB | All About Acronyms | All About Private Insurance |
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What is ELMAC
Amgen has locations across the globe and is comprised of three regions, we are a part of this region
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What is DLQI
This measurement tool is used specifically by dermatologists
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What is 65 years
This is the age that an individual can qualify for ODB Seniors
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What is Limited Use
This is what LU (Code) stands for
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What is Special Authorization/Prior Authorization
SA/PA stands for this
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What is "To Serve Patients"
Amgen's mission
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What is HAQ
This measurement tool assesses the level of difficulty, discomfort and related pain in performing activities of daily living
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What is Trillium Drug Program
This plan has an annual deductible based on household income split into quarterly payments
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What is Exceptional Access Program
This is what EAP stands for
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What is Annual or Lifetime
The two types of maximums can insurance plans have
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What is Horizon Therapeutics
Amgen recently acquired this pharmaceutical company
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What is Psoriasis
DLQI is used to assess this particular condition
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What is ODSP
This plan requires a specific MD assessment for coverage
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What is Health Assessment Questionnaire
This is what HAQ stands for
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What is the birthday rule. It applies when a child is covered under both parents' health plans. Primary coverage comes from the plan of the parent whose birthday (month and day only) comes first in the year, with the other parent's health plan providing secondary coverage
If your patient is a child and is covered under both parents, this rule is how it is determined which parent’s plan acts as the primary payor and which one will be secondary
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What is Ugur Gunaydin
Our GM’s name, please spell it out
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What is BASDAI
This measurement tool evaluates level of fatigue, back, neck or hip pain, level of pain/swelling in joints, tender areas to touch or pressure, level of discomfort upon awakening and morning stiffness duration
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What is being 24 years and younger with valid OHIP coverage and not having access to any other drug plans
These are the two requirements for an individual to be covered under OHIP+
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What is Bath Ankylosing Spondylitis Disease Activity Index
This is what BASDAI stands for
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A plan maximum is when a plan has a dollar limit (either annually or lifetime) that it can pay out before the plan is considered “maxed out” and can no longer be used. For example, a plan can only cover up to $5000 annually.
A copay maximum is when a plan has a dollar limit that the patient has to pay out of pocket in copayments till coverage slides to 100%. For example, a plan covers 80% of the patient’s drug and the remainder 20% must be paid out of pocket by the patient. However there is a copayment maximum of $100. This means that once the patient pays $100 out of pocket for any medication/s being covered by the plan, their coverage will slide to 100% instead of the original 80%.
This is the difference between a plan maximum and copay maximum
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What is Be Science-Based, Compete Intensely and Win, Create Value for Patients, Staff and Stockholders, Be Ethical, Trust and Respect Each Other, Ensure Quality, Work in Teams, Collaborate, Communicate and Be Accountable
Amgen has 8 values, list 2 of them
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What is Arthritis (HAQ), Ankylosing Spondylitis (BASDAI)
HAQ and BASDAI are used to assess these two diseases
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What are ODB (Seniors), Trillium Drug Program, OHIP+, ODSP, Ontario Works
These are the five Ontario public drug programs
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What is Special Authorization Digital Information Exchange
This is what SADIE stands for
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What is “Assignment of Benefits”. The process is as follows: The pharmacy fills out the assignment of benefits form and submits it to the insurance. This will enable them to act as a third party, they can bill claims to the patient’s plan and get reimbursed on patient’s behalf so the patient does not have to pay for the drug upfront.
If a patient has a manual billing plan and is unable to pay for the cost of the drug upfront, this is a process that we as a program can inquire about from their insurance company where we can possibly avoid having to have the patient pay for the drug upfront. For bonus points explain this process ????
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