CABENUVA resources

Specialty Drug Coverage Transcript

SUPER: The Access and Acquisition Series: Specialty injectable drug coverage options

VISUAL: The Access and Acquisition Series: Specialty injectable drug coverage options

VISUAL: A vial appears on the screen with the text "Acquire, handle, and administer. " The vial remains as the copy "Specialty drugs" slides in. The vial and "specialty drugs" remain.

VO: The way you acquire, handle, and administer specialty drugs can differ from oral medications available at traditional retail pharmacies.

VISUAL: The hand grabs the vial. The hand holds the vial.

VO: How your patients' insurance covers these drugs also differs. Let's learn about the various ways payers can cover these specialty injectable drugs.

VISUAL: Icons begin flying in. Icons continue flying in. A piece of paper flies off the clipboard. The paper and the clipboard remain in the frame. The paper and clipboard remain in place while a hand and the word “Medicaid” appear on the right.

VO: As you may know, commercial insurance, Medicare, and Medicaid structure their benefits differently.

VISUAL: The clipboard moves to the back of the screen as the other icons fade away. The paper comes to the front of the frame, while a hand holding a vial comes in from the left.

VO: This can impact how you acquire these drugs. These payers may cover drugs, services, and treatments through different benefits. Depending on how your patients’ insurance policies are written,

VISUAL: The paper and the hand remain, while a gloved hand holding a syringe comes in from the right. As the paper moves, it flips, revealing “Insurance Policy” written across the top. Hands appear from the edges of the screen. The hands appear on screen. The paper moves off the screen, while a doctor comes in from the lower right. "Medical benefit" appears on the screen. "Pharmacy benefit" appears, shifting "medical benefit" to the left. A plus animates between the medical and pharmacy benefit iconography.

VO: and whether their drugs are self-administered or administered by a healthcare provider, their specialty injectable drugs may be covered under a medical benefit, meaning their medical insurance, a pharmacy benefit, or some combination of the two. A benefit verification will detail your patient’s specific coverage—and remember, no matter what coverage your patient has,

VISUAL: A check mark appears above the iconography.

VO: these drugs may require a prior authorization before approval.

VISUAL: The hand sweeps across the screen and sweeps away the iconography. The hand continues sweeping across the screen, revealing the copy "What does it mean for your practice?" The hand exits the frame; the text remains. The "medical benefit" iconography appears with a medical building and doctor. The shot pans to reveal a warehouse. "Specialty Distributor" appears next to the warehouse as the door opens.

VO: So, what does this all mean for your practice working to acquire a specialty injectable drug? If the payer covers your patient’s drug under their medical benefit, it may be acquired through a specialty distributor,

VISUAL: A truck drives out of the open door with the words "Buy & Bill" on it. The truck drives toward the foreground of the shot. A container forms. The doctor, taking notes, appears to the right of the container.

VO: via a process commonly known as Buy & Bill. This is when your practice purchases and stores the drug until you administer it to a patient.

VISUAL: The doctor and container sweep off the screen to the left and a hand holding a vial swings in from the right. The hand lands center screen and places the vial down as the copy "pharmacy benefit" appears adjacent to it.

VO: If the payer covers your patient’s drug under their pharmacy benefit,

VISUAL: Vials and a mortar and pestle appear on the screen alongside a call center operator as the words "specialty pharmacy" populate. The "specialty pharmacy" icon begins moving off the screen to the left as a paper moves into the shot from the right. The paper is revealed to be a prescription pad with a doctor's handwriting on it. The hand moves off the screen and a vial slides out from behind the pad.

VO: it may be acquired through a specialty pharmacy. With a specialty pharmacy, a prescription is written for that patient and the drug is sent to your practice

VISUAL: The paper continues moving around the vial. The vial and prescription paper fall into the bag. The vial and prescription paper enter the bag. The bag’s top is closed. “White Bagging” copy appears.

VO: when it is nearing the time of administration. This is also called "white-bagging."

VISUAL: The shot pans out to reveal the doctor holding the bag. The doctor and a medical building appear on screen. The "medical benefit" and "specialty pharmacy" iconography appear, with an unidentified link shown between them. The unidentified link is populated with “assignment of benefits (AOB)” iconography.

VO: If your patient’s insurance covers the drug under the medical benefit, but you and your practice would prefer working with a specialty pharmacy instead of a specialty distributor, your practice may have the option to acquire the drug through an Assignment of Benefits, or AOB.

VISUAL: The screen splits, revealing a call center operator and a health care professional (HCP) on the phone. The split screen collapses, leaving the HCP onscreen. A door appears.

VO: You will determine if working with a specialty pharmacy is possible given your patient's coverage.

VISUAL: The doctor begins speaking to a patient. The shot continues moving; the doctor and patient move off the screen to the left. An office manager at her desk begins appearing from the window.

VO: Please note that this process varies by payer and will not be an option in all cases. As you can see, specialty injectable drugs are covered differently and may require adopting a new process in your practice.

VISUAL: A patient is shown sitting across from the office manager. More patients populate behind the seated patient. Camera pans right to show more patients onscreen. More patients are revealed as the camera continues to pan right. Camera zooms in through doors, revealing a park where various activities are taking place.

VO: To help more people access HIV medications, assistance from ViiVConnect is available. ViiVConnect is committed to helping inform healthcare providers about the options available for acquiring ViiV medicines so you can continue to support your appropriate patients. Contact your ViiV Team or visit ViiVinjectables.com to learn more.

SUPER: ViiVinjectables.com

VISUAL: Camera continues to pan to reveal people taking part in various activities, like walking a dog.

VO: Be sure to watch other videos within the ViiV Access and Acquisition series to learn more about working with specialty distributors and specialty pharmacies.

VISUAL: The camera pans to reveal the final frame, which says: The Access and Acquisition Series

[ViiV Logo]

Trademarks are owned by or licensed to the ViiV Healthcare group of companies.

©2022 ViiV Healthcare or licensor.

CBTVID220014 September 2022 Produced in USA.

Video 3: Specialty Distributor with Buy & Bill Transcript

SUPER: The Access and Acquisition Series: Buy & Bill acquisition process

SUPER: Specialty Drugs

SUPER: Treatment and prevention

VISUAL: A park scene appears, with the wind blowing. A leaf blows into the frame. The leaf blows past faces of patients and the words Specialty Drugs slide in from the right. The words Specialty Drugs are now in full view, while the figures continue to slide to the left. The words Treatment and prevention appear in the frame. The people and text slide off to the left as a clipboard animates in.

VO: Accessing specialty drugs may be a new experience for your practice. But understanding how to integrate these specialty drugs into your practice can help provide additional options for your patients. Obtaining these drugs requires processes that may differ from oral medications.

SUPER: Commercial Insurance, Medicare, Medicaid

SUPER: Medical Benefit

VISUAL: Supers appear onscreen with their corresponding icons. The icons fall off the screen. The HCP animates in. The Medical Benefit iconography animates in. The Medical Benefit icon and words swoop up out of the frame.

VO: The method you will use to acquire these drugs is dependent on your patient’s insurance coverage. In this video, we’ll discuss the specifics of acquiring a specialty injectable drug when your patient’s insurance covers it under the medical benefit.

SUPER: 3 options

SUPER: Buy & Bill

SUPER: AOB Assignment of Benefits

SUPER: ASA Alternative Site of Administration

VISUAL: Paper swirls around a vial that spins and comes into the frame, and the words 3 options appear. Buy & Bill and its icon appear in the center of the screen. AOB Assignment of Benefits and its icon appear in the center of the screen. ASA Alternative Site of Administration and its icon appear in the center of the screen.

VO: Under the medical benefit, there are three options: the Buy & Bill process with a specialty distributor, an Assignment of Benefits, or "AOB," or through an "ASA," which stands for Alternative Site of Administration.

SUPER: Buy & Bill

SUPER: Specialty Distributor

VISUAL: The Buy & Bill icon is at the center of the frame. The Buy & Bill text and icon shift to the left as a woman on the phone comes in from the right. A cube comes in from the left, shifting focus away from the woman on the phone. The building increases in detail revealing the specialty distributor building with the words Specialty Distributor appearing next to the building.

VO: Let’s begin with Buy & Bill. Buy & Bill is the most common acquisition method under the medical benefit. The process is known as Buy & Bill as your practice will purchase the drug directly from a specialty distributor and bill the payer for reimbursement.

SUPER: 5 Key Steps

SUPER: 1 - Benefit Verification and Payer Contract Review

2 - Prior Authorization

3 - Purchasing and Stocking the Drug

4 - Administration

5 - Billing and Reimbursement

VISUAL: Copy appears onscreen. A piece of paper is seen with the words Benefit Verification on it. Two icons appear on either side. A hand checks a box on the piece of paper. The icons all shift clockwise and an image of vials in a box appears; one is out of the box more than the others. The images shift again–clockwise–and a vial and syringe take the center of the frame. The image shifts clockwise again while a hand appears with a bill. The syringe and paper disappear and only the box with vials and a bill are onscreen. The bill swoops away from the rest of the imagery on the frame.

VO: There are five key steps in the Buy & Bill process: benefit verification and payer contract review, prior authorization, purchasing and stocking the drug, administration, and finally, billing and reimbursement.

SUPER: Medical Benefit

VISUAL: A piece of paper swirls onscreen. A hand reaches for the swirling paper and writes on it. Two health care professionals (HCPs) stand looking over the paper. One HCP slides off screen to the right; the other remains. The HCP receives a clipboard. The Medical Benefit iconography reappears. The Medical Benefit icon shifts as a manila folder with Prior Authorization appears.

VO: First, your practice will conduct a benefit verification. This step is always needed to confirm your patient’s coverage and detail any prior authorization requirements. For drugs covered under the medical benefit, a prior authorization is usually needed.

VISUAL: The manila folder shifts to the left and paperwork comes in from the right. The paperwork goes into the folder. A doctor writing a letter appears from the right. The doctor fades away and the letter goes into the manila envelope. Charts appear from the right. The charts go into the manila folder. A paper with Test Results appears from the right. The test results go into the manila folder. A paper and a vial appear from the right. The paper and vial go into the manila folder. A checklist and hand appear from the right. A stamp appears and the paper swoops up.

VO: To obtain a prior authorization, some payers require the completion of a specific form, and others require documentation such as a letter of medical necessity, chart notes, test results, or the Prescribing Information for the drug. Your patient’s payer should supply you with a list of requirements to properly complete their prior authorization process.

VISUAL: The prior authorization folder returns to the center of the frame and the stamp presses on the folder leaving an approval check. The stamp increases in size. The stamp moves out of the frame. A bill comes out of the folder. Another bill comes out of the folder and sits below the first bill. The folder now says Payer Contract. The papers return to the folder and fall on the HCP's desk. The shot zooms in on the folder as the papers file into it. The folder swirls on the screen.

VO: While verifying your patient’s benefits, your practice should confirm contract details with the payer to understand reimbursement for the administration and product costs for the drug. These contracts should be in place for all the payers your practice works with.

SUPER: Specialty Distributor

VISUAL: A hand holding a checklist appears. Another hand with a pen appears. A large box animates above the paper. The hand checks off boxes on the paper. The paper floats out of the hands and swirls upward. The Specialty Distributor icon appears. A truck pulls out of the Specialty Distributor warehouse. The truck drives away from the Specialty Distributor warehouse. The box opens and a vial rises out.

VO: Once the payer contract is confirmed and prior authorization is approved, your practice will contact a specialty distributor to acquire the drug. Your ViiV team can supply you with a list of specialty distributors to work with.

VISUAL: The vial rotates above the box. The vial returns and the box closes. The box appears in its storage container. The HCP is shown to the right of the container.

VO: Your practice will then place an order for the specialty injectable drug to stock on-site so it is available when needed.

SUPER: What are the return or payment terms with the specialty distributor?

When will the product be shipped?

Is the patient scheduled for administration after the shipment arrives?

Does the product require special handling or storage?

VISUAL: The HCP reviews the boxes in the container. Papers begin swirling around the HCP. Papers begin swirling around the HCP. A paper sits on the left of the screen with a list of questions beginning to appear on the right. The paper is replaced with a calendar and a hand truck with a box. Another question appears to the right. The hand truck disappears and a person in a chair appears behind the calendar. Another question appears on the right. A thermometer, vial, and box appear on the left. Another question appears on the right.

VO: There are a few key questions to keep in mind as you’re working with the specialty distributor on your order. What are the return or payment terms with the specialty distributor? When will the product be shipped? Is the patient scheduled for administration after the shipment arrives? Does the product require special handling or storage?

VISUAL: A calendar appears. A syringe lands on a day on the calendar. The calendar page turns to reveal a patient sitting across from an HCP. The patient and HCP slide offscreen to the right and an envelope and bill appear on the left. The bill is now in the center of the screen. The bill starts to go into the envelope.

VO: Once your practice has ordered or stocked the drug, you can schedule an administration appointment for your patient. After administration, your practice will bill the patient's insurance to get reimbursed for the administration and product costs for the specialty injectable drug.

SUPER: Product

SUPER: Administration

VISUAL: The bill folds into the envelope. The envelope seals and a hand remains in the frame. A magnifying glass looks at the barcode on the bottom right corner of the envelope. A billing code is revealed.

VO: Your practice is responsible for collecting any co-pays or coinsurance for the product, office visit, or additional administration fees from the patient. To facilitate accurate reimbursement, ensure your billing codes are correct.

VISUAL: A woman appears on the phone. Between the woman on the phone and the bill, a man in a call center appears in the center of the screen, dividing the frame into three parts. The bill on the left side of the frame swoops to the right of the screen over the two people on the phone. An office setting appears. The envelope continues off the screen and a check mark appears to the right of the man in the office. The envelope flies into another office with another person working on a computer. The envelope swoops past the man on the computer and another check mark appears on screen.

VO: You can contact your ViiV team to support you with billing information before submission to the payer. Some provider offices even assign specific individuals within the practice to own different steps of this process. Working as a team can help with accountability and efficiency for the Buy & Bill process.

SUPER: Buy & Bill

VISUAL: The man in an office and man in a call center appear in the background as a doctor appears in the center of the screen with a barcode and the words Buy & Bill in the top right. The doctor moves to the left of the screen while a cell phone with the word ViiV moves to the center. The frame transitions with the flip of a page from the top right. A container appears next to the barcode. A box is removed from the container and a vial comes out of the box. The box returns to the container. The container slides off the screen to the left and the barcode moves into a person's hand to the right.

VO: If it is your practice’s first time doing the Buy & Bill process, we recommend connecting with a member of your ViiV Team before beginning to help prepare your practice. The Buy & Bill process allows your practice to have the specialty injectable available on site and ready for appropriate patients.

SUPER: You may have other options

SUPER: Medical Benefit

SUPER: Assignment of Benefits (AOB)

SUPER: Assignment of Benefits (AOB), Specialty Pharmacy, Specialty Distributor, Specialty Drugs

VISUAL: The hand gestures to the right and the hand and barcode move off screen. The camera zooms out from the hand revealing the Medical Benefit icon. The camera pans around the HCP. The Assignment of Benefits icon appears. The specialty pharmacy and specialty drug icons begin forming. The screen fills with the flow chart of assignment of benefits to specialty pharmacy to specialty drug. The camera continues to pan, revealing the flow chart of assignment of benefits to a specialty pharmacy to specialty drug. Specialty distributor is crossed out in the background.

VO: Another method that may be covered by your patient's insurance under the medical benefit is Assignment of Benefits, or AOB. An Assignment of Benefits is a process under the medical benefit that may allow you to access a drug through a specialty pharmacy instead of a distributor.

VISUAL: The Specialty Distributor icon fades away. The Alternative Site of Administration icon begins to come into the frame and the other icons fade away to the left.

VO: Please note that this process varies by payer and will not be an option if your patient's plan does not allow for assignment of benefits for a specialty pharmacy under a medical benefit.

SUPER: Alternative Site of Administration (ASA)

VISUAL: The Alternative Site of Administration icon takes center frame. The camera zooms out, revealing an HCP holding a screen with a map on it. The camera zooms out further to reveal an HCP showing the screen to a patient. The setting changes and the patient is now at the alternative site of administration shaking a doctor’s hand. A paper swooshes across the screen. The paper comes to the center of the frame with the words Benefits Verification across it. The page peels back, revealing a doctor with  a box, a thermometer, and a vial next to them. The doctor turns and moves to the left as a bill is being inserted into an envelope on the right. The screen is split between the doctor with the bill and an HCP with a clipboard.

VO: An additional option is utilizing an alternative site of administration, or ASA. This is a facility, oftentimes an infusion center, that can conduct a patient’s benefit verifications, acquire and administer the specialty injectable drug, and handle the billing and reimbursement instead of your practice.

VISUAL: The split screen transitions to focus on the HCP in their office. The camera pans around the HCP revealing their laptop screen. The HCP sits in front of her laptop. Another HCP appears. The laptop screen displays the ViiV Healthcare logo. The three people and laptop slide to the left and a doctor's office slides in from the right with patients sitting in a waiting room. The patients sitting in the waiting room continue to slide to the left.

VO: In summary, learning to navigate the medical benefit is vital to bringing specialty injectable drugs to your patients. Your ViiV Team is available to support you throughout the entire acquisition process, and ViiVConnect is available to help further support you and your staff through working with payers if you choose to utilize the service.

SUPER: ViiVinjectables.com

SUPER: The Access and Acquisition Series

SUPER:

[ViiV Logo]

Trademarks are owned by or licensed to the ViiV Healthcare group of companies.

©2022 ViiV Healthcare or licensor.

CBTVID220015 September 2022 Produced in USA.

VISUAL: The camera zooms in on a person in front of a computer. The woman in front of a computer comes into the frame. The camera pans around the woman at her desk. The camera continues to pan around the woman at her desk. The woman is shown at their desk with a patient. Additional individuals populate around the seated patient. The camera shows a group of patients. A leaf blows past the patient and the background shifts to an outdoor space revealing a patient walking with his partner and dog. The camera pans to reveal the ending frame with the words The Access and Acquisition Series.

VO: For more on accessing and acquiring specialty injectable drugs, review the other videos in this series. And, if you have questions about acquiring specialty injectable drugs covered under the medical benefit, or how ViiVConnect can support you and your patients in this process, please reach out to your ViiV Team or visit ViiVinjectables.com to learn more.