Medication Payment Decision tree North Dakota You can

Medication Payment Decision tree: North Dakota You can apply to Gilead’s Support program (if Harvoni or Epclusa is prescribed) Medicaid or Medicare A or B (hospital coverage) Patient Assistance Program Eligible and can claim AI/AN Exemption You can apply to Abb. Vie Patient Assistance Foundation (if Mavyret is prescribed) YES Does the patient have insurance? Medicaid Expansion Formulary Preference PA criteria similar to ND Mediciaid. More info at http: //www. hidesigns. com/ ndmedicaid/pdl/ You can fill the medications at a specialty pharmacy and ship the medications to the doctor’s office Medicare Part D (Prescription Coverage) Formulary Preference (call insurance company) You can elect to fill the medications at your pharmacy or order medications through CMOP or Mc. Kesson Fill out one of the following: 1. Online application: i. Assist: https: //www. assistrx. com/iassist/ OR 2. Paper application: fax to Gilead, download form at: http: //www. npaihb. org/wpcontent/uploads/2018/02/Support_ Path_Intake_Form. pdf The Patient assistance program is a paper form. You can download the form at: http: //www. npaihb. org/wpcontent/uploads/2018/02/abbvi e-mavyret-PAP. pdf Step 1: If you receive a denial letter from the patient’s Insurance then go to step 2. If approved go to step 4. Fill out one of the following: You can apply to Gilead’s Support program (if Harvoni or Epclusa is prescribed) NO Then the patient is Patient Assistance Program Eligible and can claim AI/AN Exemption You can apply to Abb. Vie Patient Assistance Foundation (if Mavyret is prescribed)* *Please note that this option is still being explored 1. Online application: i. Assist: https: //www. assistrx. com/iassist/ OR 2. Fill out a paper application and fax the form to Gilead. You can download the form at: http: //www. npaihb. org/wpcontent/uploads/2018/02/Support_ Path_Intake_Form. pdf Fill out the Patient assistance program form. The form can be downloaded at: http: //www. npaihb. org/wpcontent/uploads/2018/02/abb vie-mavyret-PAP. pdf Medications are shipped from Theracom pharmacy The medications are shipped from Theracom pharmacy You can elect to have the medications shipped to a doctor’s office Step 4: You can elect to have the medications shipped to a doctor’s office Step 2: You can appeal and if you receive a second denial letter, you can apply for patient assistance Step 3: Approved!