2015 Lone Star Script Care LLC ALL AGENTS ARE REQUIRED TO READ AND UNDERSTAND ALL OPERATING POLICIES AND PROCEDURES.

Transcription

1 2015 Lone Star Script Care LLC ALL AGENTS ARE REQUIRED TO READ AND UNDERSTAND ALL OPERATING POLICIES AND PROCEDURES.

2 MARKETING MATERIALS ORDER FORM FAX TO: MARKETING MATERIALS ORDER FORM EFFECTIVE MAY 1 ST 2015 AGENT NAME: LSSC AGENT #: DISCOUNT DRUG CARDS ITEM# DESCRIPTION UNIT PRICE QTY. TOTAL LSSC1 DISCOUNT RX CARDS 1 $ ,500 $ LSSC2 DISCOUNT RX CARDS 1 $ ,000 $ LSSC3 DISCOUNT RX CARDS 1 $ ,000 $ FLIERS LSSC4 DISCOUNT RX CARD TAKE ONE 1* $ $ LSSC5 DISCOUNT RX CARD TAKE ONE 1* $ $ LSSC6 DISCOUNT RX CARD RECRUITING FLIER 1 1* $ $ LSSC7 DISCOUNT RX CARD RECRUITING FLIER 1 1* $ $ LSSC8 PRESCRIPTION CONCIERGE FLIER 1* $ $ LSSC9 PRESCRIPTION CONCIERGE FLIER 1* $ $ DISPLAY CASES LSSC10 Single Pocket Acrylic Business Card Holder for Table 1* $ $ LSSC11 5 x 7 Business Card Holders with Slant Back Design, Pocket for Business Cards Clear 1* $ $ LSSC12 4 x 9 Brochure Holder for Tabletop or Wall, with Business Card Pocket Clear 1* $ $ LSSC x 11 Sign Holder with Pocket for Business Cards, Slant Back Clear 1* $ $ MISCELLANEOUS LSSC14 PRESCRIPTION ASSISTANCE OVERVIEW PRESENTATION 1* $ $ LSSC15 PRESCRIPTION ASSISTANCE FORMULARY 1* $ $ LSSC16 PRESCRIPTION ASSISTANCE DR OFFICE INTAKE FORMS/FLIERS 1* $ $ LSSC17 FREE RX CARD OPPORTUNITY PRESENTATION 1* $ $ LSSC18 AGENT TRAINING MANUAL 1* $ $ *If you wish to purchase more than the quantities stated simply multiply the pricing and quantity to reflect the desired amount. Example: You wish to purchase 60 of LSSC10. Simply multiply $0.50c x 60 = $30.00 LSSC19 SHIPPING FEE $3.00 I WANT TO PAY FOR MY MARKETING MATERIALS BY: Account Type: Visa MasterCard AMEX Discover Cardholder Name Account Number Expiration Date CVV2 (3 digit number on back of Visa/MC, 4 digits on front of AMEX) SIGNATURE SHIPPING ADDRESS: CITY: STATE ZIP TOTAL DUE LONE STAR SCRIPT CARE... DATE $ Please allow 14 days for delivery.

3 MARKETING MATERIALS ORDER FORM MARKETING MATERIALS ORDER FORM EFFECTIVE MAY 1 ST 2015 DISCOUNT DRUG CARDS - LSSC1 RECRUITING FLIER 1 - LSSC6 DISCOUNT RX CARD TAKE ONE - LSSC4 PRESCRIPTION CONCIERGE FLIER

4 MARKETING MATERIALS ORDER FORM EFFECTIVE MAY 1 ST 2015 LSSC10 Single Pocket Acrylic Business Card Holder for Table 4 x 9 Brochure Holder for Tabletop or Wall, with Business Card Pocket Clear 5 x 7 Business Card Holders with Slant Back Design, Pocket for Business Cards Clear 8.5 x 11 Sign Holder with Pocket for Business Cards, Slant Back Clear

5 PRESCRIPTION DRUG CARD MEMBER ID# (PATIENT PHONE #) PHARMACY HELP DESK (877) Present this card and your prescription(s) to any participating pharmacy. At the time of service you are responsible for the payment of your prescription. THIS IS NOT INSURANCE - PRESCRIPTION SAVINGS CARD ONLY This program is VOID WHERE PROHIBITED BY LAW RxBIN: RxPCN: APSRX RxGRP: If You Cannot Afford Your Prescriptions, Please Call: Prescription Assistance Hotline

6 Pharmacist:Clearanypriordiscountinformationfrom thepatientfile. Ifprimarycoverageexists,enterthiscardinformationas secondarycoverage.program notvalidifprescriptionsare paidinfulorpartbyanystateorfederalyfundedprogram. PharmacyHelpDesk: Ifyoucannotafordyourmedications,pleasecal: Patient Assistance Hotline: THISISNOTINSURANCE-VOIDWHEREPROHIBITEDBYLAW

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8 PRESCRIPTION CONCIERGE SERVICE Gain Access to Valuable Patient Assistance Programs for Your Most Costly Prescription Needs Introducing the Prescription Concierge Service Program available through Lone Star Script Care Gain unique access to leading drug manufacturer s patient assistance programs to save you money on specialty medications that may not be covered by your current health plan. Let our concierge service help you see if you qualify for special programs offered by the drug manufacturer s to lower your out-of-pocket costs. Access to the Prescription Concierge Service is free. If you require a specialty medication or are taking a medication that is not either expensive and/or not covered under your current health plan, our Prescription Concierge Service can help! After a brief evaluation, if you are unable to qualify for a patient assistance program for the medication you require, your concierge specialist will work with you to find the absolute lowest cost way to obtain your medication. Learn More Today! Simply call the number below to be connect with a concierge specialist who can walk you through options for you specific medication. To get started simply call: Agent #

9 There May Be A Solution! If You Answer "YES" to Any of The Two Questions, You May Qualify For Free Prescriptions! Are You Spending More Than $30 A Month On Your Prescription Medications? Is Your Household Income Less Than $60,000 (couple/family) or $30,000 (individual)? Contact An Agent Today! Your Agent:

10 Attention: Healthcare Providers Do You Have Patient s Tell You They Cannot Afford Their Medications? Is Your Staff Overwhelmed With Patient Assistance Programs and Their Paperwork Requirements? We can handle the qualification paperwork, refills and general management for you while you concentrate on doing what you do best: Providing Patient Care Most drug manufacturers sponsor Patient Assistance Programs. These programs are for those who have problems in obtaining their prescription drugs due to cost. Our goal is to educate and inform patients, physicians, healthcare providers and other agencies that these programs are available. We will: To Get Started: Review all available assistance programs for your patient(s) Access, complete and process all necessary forms and requirements. Simply complete the attached intake form and fax to us at: We review with the patient any programs they may qualify for and handle the rest! Keep the patient informed and educated on all available options that best fits their needs.

11 Agent/Advocate ID Applicant Name: First: Last: Home Phone: Cell Phone: Best Time To Contact: Day: Time: AM or PM Best Number To Contact: Home Cell State: Does The Applicant Currently Have Prescription Drug Coverage? Is The Applicant Enrolled in Medicare? YES NO Is The Applicant Enrolled in Medicaid? YES NO Size of Household: Approximate Annual Income: Medication Information YES FAX TO: Intake Form: Prescription Assistance Rx Name Strength Dosage (per day) Cost Per Month NO Additional Information:

12 Can t Pay For Your Medications Even With A Discount Card? Struggling With The High Cost Of Prescriptions? No/Limited Prescription Drug Coverage? Paying Too Much For Prescriptions? Can t Afford Your Medications Even With A Discount Card? Spending $60, $100, $200 or More Per Month? Highlights of Our Program.May Be Able To Help. Access, Complete And Process All Forms For You Stay Current On Program Changes For You Free Review Of Over 300 Programs That May Help You Save On Your Medications Inform And Educate You On The Options That Best Fit Your Needs Handle All Reapplications For You $20 Per Month Per Medication That We Help You Get For Free! Eligibility Requirements Limited or No Prescription Drug Coverage Income No Higher Than 300% Of The Federal Poverty Level Medications Must Be In A Program Must Be US Citizen or Lawful Permanent Resident These Programs Are Available Regardless Of Age Or Employment Status Apply Online: Apply By Fax: