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Avoiding Pharmageddon : H elping Patients Stay on their Medications T hrough their Transitions

Avoiding Pharmageddon : H elping Patients Stay on their Medications T hrough their Transitions. Tjost at Woot !. November 20, 2013 Kathleen Clanon, MD Sophy Wong, MD. Interactive Panels. Chat. Mute. Raise Hand. 2. Participant Evaluation Form (PEF).

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Avoiding Pharmageddon : H elping Patients Stay on their Medications T hrough their Transitions

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  1. Avoiding Pharmageddon: Helping Patients Stay on their Medications Through their Transitions Tjost at Woot! November 20, 2013 Kathleen Clanon, MD Sophy Wong, MD

  2. Interactive Panels Chat Mute Raise Hand 2

  3. Participant Evaluation Form (PEF) At the conclusion of today’s session, please use the following URL LINK to complete your participant evaluation form: https://aetcnec.virtualforum.com/pefidform.cfm?erid=24997&sc=533834&aetccode=12 We will also email the link to you as well. 3

  4. Avoiding Pharmageddon: Helping Patients Stay on their Medications Through their Transitions Tjost at Woot! November 20, 2013 Kathleen Clanon, MD Sophy Wong, MD

  5. Objectives Pharmageddon

  6. What is still unclear?

  7. Bad Medi-Cal letter

  8. Bad Medi-Cal letter

  9. Legal immigrants <5 years and <138% FPL…are now are eligible to enroll in state-funded Medi-Cal!

  10. Legal immigrants <5 years and <138% FPL…What’s going to happen to Maria?-In US since 2010-Makes $10k/year

  11. Alameda Alliance is not yet approved as a Covered CA plan.…stay tuned to see if they will be available starting in Feb/March 2014 (patients can consider waiting).

  12. Alameda Alliance is not yet approved as a Covered CA plan.…What’s going to happen to John?-US citizen-Makes $18k/year-Oncologist only takes Alameda Alliance

  13. Pharmageddon Tjost at Woot!

  14. Pharmageddon

  15. Pharmageddon

  16. Pharmageddon

  17. Pharmageddon

  18. Pharmageddon . Lost in the Managed Care Crowds

  19. Pharmageddon Avoiding HPAC to Medi-Cal transitions • Timely authorizations • Emergency 72 hour supply • Non-formulary drug stabilization • Carve-out for mental health and substance abuse medications

  20. Formularies Matter: Medi-Cal plans Alameda Alliance vs HPAC • 17 unique drugs not covered • 40% of the covered drugs require PA and additional documentation (ie: step therapy) Blue Cross vs HPAC • 2 unique drugs not covered • 3% of the covered drugs require PA  

  21. Strategies you can use! • Remind patients to bring in mail • Know who needs Covered CA and Medi-Cal enrollment • Know your enrollment counselors

  22. What is your plan?

  23. Questions? Comments?

  24. East Bay AIDS Education & Training Center Sophy Wong, MD, Medical Director Shailey Merchant Klinedinst, MPH, Program Manager Gracie Askew, Training Manager (510) 835-3700 phone (510) 625-9307 fax www.eastbayaetc.org 25

  25. Participant Evaluation Form (PEF) Please use the following URL to complete your participant evaluation form: https://aetcnec.virtualforum.com/pefidform.cfm?erid=24997&sc=533834&aetccode=12 We will also email the link directly to you as well. Thanks! 26

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