Step-by-step appeal worksheets
Our checklists increase the likelihood of a successful appeal.
We provide a list of the key documentation needed and tips to expedite your request.
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Utilization management hurdles
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Repeated, frequent prior authorization requests
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Non-medical switching
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Dose and/or frequency limitations
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Become an expert on payor policies
Economic burden of IBD
Topics covered within this infographic include how payors are likely aware that the incidence and cost of IBD are increasing but most of the spend for IBD is in the inpatient and emergency department.
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Become an expert on payor policies
Understanding payor drug use management initiatives
In this downloadable infographic you’ll learn how several different tactics may be used as part of a drug use management strategy, the overall goal of which is to ensure appropriate medication use.
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Become an expert on payor policies
Managing change in health care insurance
Learn about challenges and solutions related to transitions in health care coverage, non-medical switching, site of care concerns, and emerging treatments.
Test your knowledge
Test your knowledge on the above infographics and worksheets by taking this quiz. Besides being a fun way to verify your understanding, the feedback is helpful to AGA to confirm the information was presented in an easy-to-understand manner.
Insights
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Dana McCormick, RPh, FAMCP, Optum
Senior Director, Pharmacy Advisory Services
“I have seen the influence of specialty society guidelines on payors’ decisions. Other than randomized clinical trials, specialty societies are the first place payors go to get more information.”
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Rocio Castrillon, MBA, @VoiceForIBD
“Patients do tend to have more success with appeals when verbalizing the direct effects we are experiencing due to a delay in authorization. I believe having patients be able to do some of the follow-up allows for the opportunity for the patient to not only be proactive, but also not have to be sitting around waiting for an authorization to go through.”