2021-5-13 faqs savella copay savings programs-variable otf

of 12 PM_008_Form ConnectiveRx CS FAQs Template V3

ConnectiveRx Contact Center Program Guides Customer Service Reference Guide

Date Revision Description CONNECTIVERX PM 11/26/18 Original Kim Mayer 12/03/18 Updated Q#3 Kim Mayer 4/24/2019 Add new OTF program with

group# EC51028002-2019 Savella – CVS Pharmacy-OTF, and update concurrent linking so patient does not exceed 12 uses total across groups.

Kim Mayer

5/15/19 Effective 5/24/19: Updated #32 reporting form and email addresses.

Kim Mayer

8/15/19 Added MANUAL APO Bill Code for accelerated payment option. (Reimbursement checks to be mailed to patients within 2-3 weeks from CH vs the 4-6 weeks.)

Kim Mayer

9/26/19 Updated AE #28 and PM contact information.

Kim Mayer

11/12/19 Added IDs to Group# EC51028001; Extended existing groups#EC51028001 & EC51028002 thru 12/31/2020; Updated Uses per ID to 12 per activation period; Removed Max Accum&Reset; Removed Concurrent Linking; Replace Therapeutic Dup w/Days bw Fills. Updated Opt-out #24.

Kim Mayer

02/13/20 Updated PM contact section Kristin Wellins 02/19/2020 Updated group information for

clarity Kristin Wellins

03/21/2020 Update to AE and Product Complaint Process (FAQ #28 & #29)

Ryan Dinse


11/12/2020 Effective 1/1/2021: Offer Statement Update; Extend groups EC51028001 and EC51028002 through 12/31/2021; Updated T&Cs

Debbie Danchak

5/13/2021 Updated PM Contact Ellen Bennett

Program Name SavellaCo-Pay – Variable& OTFPrograms

CS Number 1-866-262-2709

Brand Name Pronunciation Key Savella Suh – vel - la Pharmaceutical Company Pronunciation Key Allergan Al-r-gan

Offer Type COB Offer Statement Pay as little as $20 per 30-day or 90-day fill

1-30DS: ELIGIBLE PATIENTS PAY $20, THEN SAVE UP TO $100 31-60DS: ELIGIBLE PATIENTS PAY $20, THEN SAVE UP TO $100 61-90DS: ELIGIBLE PATIENTS PAY $20, THEN SAVE UP TO $250

Key Cheat Sheet Program Information

Cheat Sheet Section: Top 5 Facts

Card ID#is set to expire 365 days from the date the patient enrolled, activated and downloaded the web savings coupon.

Offer based on D/S. Effective 5/6/19: New OTF Program with new OTF group# EC51028002 - 2019 Savella – CVS Pharmacy-OTF for

CVS Program. Added MANUAL APO Bill Code for accelerated payment option. Effective : 1/1/2021 – Offer updated to the following:


Pay as little as $20 per 30-day or 90-day fill 1-30DS: ELIGIBLE PATIENTS PAY $20, THEN SAVE UP TO $100 31-60DS: ELIGIBLE PATIENTS PAY $20, THEN SAVE UP TO $100 61-90DS: ELIGIBLE PATIENTS PAY $20, THEN SAVE UP TO $250

List of NDCs Included in Offer: Drug name Strength

11 Digit NDC #: (e.g. 12345-1234-12)

SAVELLA 100mg TAB 00456-1510-60 SAVELLA 12.5mg TAB 00456-1512-60 SAVELLA 50mg TAB 00456-1550-60 SAVELLA 12.5-25-50 TAB

DS PK 00456-1500-55

SAVELLA 25mg TAB 00456-1525-60

Critical Call Flow Program Information Program Type: Pharmacy Adjudicated, Specialty, Buy and Bill, Reimbursement, Fixer, Gatekeeper. For Buy and Bill programs, please alsofill out additional section below for Buy and Bill programs.

Pharmacy.

Drug Name(s) Savella Pronunciation Key Suh-vel-la Customer Service Numbers ConnectiveRx Customer Service: 1-866-262-2709

Pharmacy Help Desk: 1-800-422-5604 Summary of Program: Copay Assistance or Buy & Bill Program? How does the program work?

This is a coordination of benefits (COB) card offer that will be available online. Although the group expiration date of this program is 12/31/2021,member IDs will be set to expire 365 days from the date the patient enrolled, activated and downloaded the web savings coupon. Retail and mail order patients may receive the following benefit based upon the tiered offer by day’s supply:

1-30DS: ELIGIBLE PATIENTS PAY $20, THEN SAVE UP TO $100, 1 use (up to a total of 12 uses) 31-60DS: ELIGIBLE PATIENTS PAY $20, THEN SAVE UP TO $100, 2 uses (up to a total of 6 uses) 61-90DS: ELIGIBLE PATIENTS PAY $20, THEN SAVE UP TO $250, 3 uses (up to a total of 4 uses)

Program Eligibility:Program is Commercially Insured Patients (no Cash patients).


available to: If drug is not covered by a commercially insured patient’s plan? What is the process? Is claim processed as cash or insured?

Only for commercially insurance but the product is not covered by their plan. Cashpatient

I am a cash paying patient, can I use this offer?

Nocash paying patients.

Are government insured patients eligible? (Example: Medicaid, Medicare, TRICARE)

No. If you are eligible for drug benefits under any such federal or state drug assistance programs, you cannot use this offer. See the card for complete terms.

State Restrictions NA Age Restrictions Valid OfferType and Offer Artwork: Include any relevant art. Web coupon, rep delivered, backers etc.

2021

Max Accum Annual Reset: (If applicable specify max accum and if reset needed every calendar year (reset every January) or 365 days from program effective date)

N/A

Concurrent Linking: N/A Easy Save Program No Activation (Hard/Soft/No Activation)

EC51028001activation.EC5102

If IVR activation, what is the avg. length of the IVR script?

N/A

If IVR activation and hard activation, please answer the following:

08_Form ConnectiveRx CS FAQs Template V3

Only for commercially Insured patients or patients who have commercial insurance but the product is not covered by their plan.

Cashpatientsare not eligible for this offer.

cash paying patients.


Valid for 18 years and older. 1 Web Savings Coupon:

EC51028001: Hard Activation, ID to expire 365 days from the activation. EC51028002:No Activation. Activation not required because group is OTF

or patients who have commercial insurance but the product is not covered by their plan.

No. If you are eligible for drug benefits under any such federal or state drug assistance programs, you cannot use this offer. See the card for complete

, ID to expire 365 days from the date of

Activation not required because group is OTF.


About how long into the IVR script will the card be activated? What does the patient hear in order to know that their card is active?

N/A

Transcriptions by CONNECTIVERX (Y/N):

No

Group #/s: Variable Groups: EC51028001 OTF Groups: EC51028002

Start/End Date: EC51028001: 12/31/2018 - 12/31/2021; EC51028002: 05/06/2019 - 12/31/2021

Manual Rebate Reject Termination Date:

1/10/2022 – this is the last day reject letters will be sent out for manual rebates

Number of Uses: 12 Min/Max day supply per use Min: 1

Max: 90+ Min/ Max Quantity per use N/A Min number days between fills/refills

75% Days Between Fills

Maximum benefit on each use/across uses:

•1-30 D/S: Patient Pays $20/$100 max cap. •31-60 D/S: Patient Pays $20/$100 max cap. •61-90 D/S: Patient Pays $20/$250 max cap.

Titration: Yes, or No No Can I continue to use my card as long as I am taking Brand X?

As long as you are eligible, you can use your card up to 4, 6 or 12 times depending on the day’s supply before the program expires on 12/31/2021. Allergan Pharmaceuticals also reserves the right to discontinue or modify the program at any time.

Is this card accepted at any pharmacy?

The Savella card is accepted at most retail pharmacies in the United States. If the card is not accepted at your pharmacy, you can get your savings via a rebate check after you have purchased your Savella prescription. In order to receive your check, please provide the following information:

The 11-digit ID# and GRP# that is found on the Savella card or a photocopy of the card.

A proof of purchase (original pharmacy receipt with pharmacy name, product name, prescription number or Rx#, date filled, quantity, and the price)

If applicable, provide a legible photocopy of the front of your primary insurance card or provide the name of your primary insurance along with BIN and PCN information found on the card


Your name, address, city, state, zip, phone number, DOB, and the out of pocket payment

Mail all of this information to: Savella Program Claims Processing Dept. PO Box 2355 Morristown, NJ 07962

Government Payor Edits: - Yes - No Claims processed in SelectRX Gatekeeper No Gatekeeper Resolution Center No

Full Program FAQs Complete Frequently Asked Questions (FAQs):

# Question

Answer

1 Do I need to activate my card before going to the pharmacy? If yes, what is the activation number for this offer?

Yes, the web savings card is activated upon patient enrollment on the Savella website www.savella.comwhen the patient downloads a web card.

2 I activated my card, but provided the wrong information. Will this affect the redemption process at the pharmacy? How can I change the information that I gave?

No, as long as your card has been successfully activated, the processing of the offer at the pharmacy will not be affected. In order to change the information, you provided, please contact 1-866-262-2709.

3 I am unable to activate my card, can you [CS rep] complete the activation process on my behalf?

Yes, please stay on the line while I read you a series of questions from the Savella website www.savella.com and I will then provide you with the group and ID # for this program.

4 I am unable to enroll in the program, can you [CS rep] complete the enrollment process on my

Yes, please stay on the line while I read you a series of questions from the Savella website www.savella.comand I will then provide you with the group and ID # for this program.


behalf? 5 I am a resident of

Massachusetts; can I use this card?

Yes

6 Can this offer be used for prescriptions reimbursed under Medicaid, Medicare, TRICARE, or any prescription drug benefit plan?


7 I have Medicare/Medicaid/Tricare, but my prescriptions are not covered, can I use this offer?

No, if you are eligible for drug benefits under any federal or state drug assistance programs, you cannot use this offer. This includes patients who may fall into the ‘doughnut hole’ or those who are paying for 100% of the prescription out-of-pocket.

8 If patient is enrolled in Obamacare or Qualified Health Plans are they eligible to use the card?

This offer is available to patients covered by Qualified Health Plans issued by Federal or State Exchanges created under the Affordable Care Act. Independent verification of offer availability by the pharmacist is required for non-Qualified Health Plans issued by the Exchanges.

9 I am a cash paying patient, can I use this offer?

No, this offer is not available to cash paying patients.

10 I have commercial insurance, but Savella is not covered by my plan, am I considered to be an insured or cash paying patient?

If you have commercial insurance, but this product is not covered by your plan, you are considered insured and are eligible for this offer.

11 I am under 18 years of age; may I use this card?

No, the offer is not valid for patients under 18 years of age.

12 Do I have to wait a number of days in between fills to get my next refill?

Yes, this program requires 75% Days between fills that you must wait in order to get your next refill.

13 Is there a maximum amount the offer will cover per use?

Yes, •1-30 D/S: Patient to pay the first $20, max cap $100; anything left over after the $100 savings is patient’s responsibility=1 use. •31-60 D/S: Patient to pay the first $20, max cap $100; anything left over after the $100 savings is patient’s responsibility=2 uses.


•61-90 D/S: Patient to pay the first $20, max cap $250; anything left over after the $250 savings is patient’s responsibility=3 uses.

14 My prescription is for a 90-day supply (90 pills), can I use the card and how many fills on the card will be used?

Yes, for 61-90 D/S: Patient Pays $20/$250 max cap=3 uses. The offer has a tiered benefit: •1-30 D/S: Patient Pays $20/$100 max cap=1 use. •31-60 D/S: Patient Pays $20/$100 max cap=2 uses. •61-90 D/S: Patient Pays $20/$250 max cap=3 uses.

15 Can I use more than one offer?

Each patient is only allowed 12 uses per ID during the activation period. Patients may have multiple card IDs.

16 Can I use this card if I have deductibles that I haven’t met?

Yes, you may use this card even if you haven’t met your deductible on your primary insurance.

17 Can I continue to use my card as long as I am taking Savella?

If you are eligible, you can use your card up to 12 times during the ID activation period before the program expires on 12/31/21. Allergan Pharmaceuticals also reserves the right to discontinue or modify the program at any time.

18 I have more than one person in my household that may be able to use the card, how can I obtain more than one card for Savella?

You will have to see your physician to receive a Savella prescription and request a card. You can also download a Savella card on the Savella website www.savella.com.

19 Can I use my card for mail order purchases?

Yes, this offer can be used for mail order purchases.

20 If my mail order pharmacy doesn’t accept these cards, can I mail in for a reimbursement?

Yes. You can get your savings via a rebate check after you have purchased your Savella prescription via mail order. In order to receive your check, please provide the following information:

The 11-digit ID# and GRP# that is found on the Savella card or a photocopy of the card.

A proof of purchase (original pharmacy receipt with pharmacy name,


product name, prescription number or Rx#, date filled, quantity, and the price)

If applicable, provide a legible photocopy of the front of your primary insurance card or provide the name of your primary insurance along with BIN and PCN information found on the card

Your name, address, city, state, zip, phone number, DOB, and the out of pocket payment

Mail all of this information to: Savella Program Claims Processing Dept. PO Box 2355 Morristown, NJ 07962

21 How long after the program expires can I still mail in for a manual reimbursement?

We will process manual reimbursement requests with a fill date on or before the program expiration date of 12/31/2021 until the program termination date of 1/10/2022. After that time, no claims will be processed. Reject letters will be sent through 1/31/2022 for manual reimbursement requests received after the program termination. CSRep – please note that after the reject termination date, all manual reimbursement requests received should be shredded.

22 I received the Savella card, does this mean I don’t need to have a prescription?

No. The Savella card is for use ONLY with a valid Savella prescription.

23 Will my personal medical data remain confidential, or will my name and address be placed on a mailing list?

Your data is confidential, and your name will never be placed on a mailing list unless you request it. Your data is protected under the Health Insurance Portability and Accountability Act (HIPAA).

24 How do I opt out of future programs?

To opt out of the (CRM) program, patients can: Send an Email to [email protected] and include Patient’s

Name and Email Address requesting not to receive any more email program communications.

Click the unsubscribe button on the email, if applicable Text ‘STOP’ to unwanted SMS messages, if applicable

25 Is there a Patient Assistance Program for patients who cannot afford this medication?

Yes, there is a Patient Assistance Program for Savella. Visit the Allergan PAP web site to learn more about the program at http://www.allergan.com/responsibility/patient-resources/patient-assistance-programs, Or call 1-(800)-851-0758 from 7:30 AM - 5:00 PM (CST), Monday – Friday, and someone will assist you.


26 Are there additional ways that I can receive extra savings? If so, is there a phone number or website I can go for these savings?

Currently there are no additional offers, but please visit the Savella website www.Savella.com for additional information.

27 What is CONNECTIVERX?

CONNECTIVERX manages copay programs on behalf of pharmaceutical companies. You can learn more about what we do by visiting us online at www.ConnectiveRx.com

28 I have experienced an adverse event or have a product complaint. Use this answer if the client has specified adverse event procedure information.

For Adverse Event: Complete the Allergan Global Patient Safety & Epidemiology Form in its entirety (Do not leave any field blank; if you were unable to obtain information; please enter unknown, N/A or not provided, as appropriate.) the form can be located: https://pdrnetwork.sharepoint.com/sites/SafetyReportingFiles/SitePages/Home.aspx Request Vendor Reference ID to be retrieved by sending an email is sent to [email protected] Upon receipt of Vendor Reference ID Number add to Allergan Global Patient Safety & Epidemiology Form, email the completed form and send to [email protected] and copy [email protected] and CC brand PM. *Please see OPS-WI-000244 for full process details* OPS-WI-000244 Allergan Adverse Event and Product Complaints Reporting Process


29 I have experienced an adverse event or have a product complaint.

For Product Complaint: Complete the Allergan Product Intake Form in its entirety (Do not leave any field blank; if you were unable to obtain information; please enter unknown, N/A or not provided, as appropriate.) the form can be located: https://pdrnetwork.sharepoint.com/sites/SafetyReportingFiles/SitePages/Home.aspx Request Vendor Reference ID to be retrieved by sending an email is sent to [email protected] Upon receipt of Vendor Reference ID Number add to Product Intake Form, email the completed form and send to [email protected] copy [email protected] and CC brand PM. *Please see OPS-WI-000244 for full process details* OPS-WI-000244 Allergan Adverse Event and Product Complaint Reporting Process

Additional Questions for Web Offers 30 When does the web

offer go live (i.e. when is the coupon available for download)?

The Savella web savings coupon is available on the Savella website www.savella.com .

31 You have said that there is a web offer, but I don’t have a computer. Can you [CS rep] go to the website and obtain an offer on my behalf and provide me the information over the phone?

Yes, I can go to Savella website www.savella.com, download a coupon for you, and provide you with the coupon information to be used at the pharmacy.


Additional Information: Brand Website: www.savella.com Brand Customer Service Number (in addition to CONNECTIVERX CS number):

ConnectiveRx Customer Service: 1-866-262-2709 Allergan Medical Affairs: 1-800-678-1605, option 2

Medical Information CS Number 1-800-678-1605, option 4 Pharmacy Help Desk #: 1-800-422-5604 For all other questions not covered by these FAQs, customer service representative please contact: ***Please note that this information is for customer service rep use only. CONNECTIVERX employees’ names, email addresses, or phone numbers should never be distributed to patients.

Lead PM: Ellen Bennett at [email protected] PM Backups: Debbie Danchakat [email protected] And [email protected]

2021-5-13 faqs savella copay savings programs-variable otf

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