ATTACHMENT K Ready Set PrEP.pdf

Market Research

To Facilitate Market Research Only, Subject to Modification 1

HUB & HUB-Plus Functions

• HUB: Engagement, Enrollment, Patient & Provider Support

• Call Center

• Web Portal

• Adherence

• HUB-Plus: Verify that Patient Lacks Prescription-Drug Coverage

• HUB-Plus: Issue Voucher (BIN and Member Number) & Claims Adjudication

• Pharmacy Support

• Wholesale-Distributor Interface. See Slide 4.

• HUB-Plus: Mail-Order Pharmacy

To Facilitate Market Research Only, Subject to Modification 2

Patient Journey: Web Portal or Call Center Is PrEP right for you or your patient?

A. Yes

• Transmit prescription to HUB OR attest that patient has PrEP-medication prescription.

Does patient have prescription-drug coverage?

Attests YES: If requested, HUB links to programs that may help with cost share.

Attests NO or I DON’T KNOW: HUB electronically verifies.

If UNINSURED: HUB issues voucher with BIN and member number.

Would patient like mail order?

YES: HUB transmits prescription and voucher to mail-order pharmacy. OR patient sends prescription and voucher to mail-order pharmacy. See Slide 5.

NO: HUB provides list of nearest brick-and-mortar pharmacies and HUB transmits prescription and voucher to selected pharmacy. OR patient brings prescription and voucher to pharmacy. See Slides 4 and 6.

B. No

• If patient is HIV positive, HUB links patient to appropriate resources.

• If patient is HIV negative and not at risk, but has questions, HUB links patient to appropriate resources.

C. I Don’t Know

• HUB links patient to options for closest low- or no-cost provider with PrEP experience based on HHS list-e.g., FQHC or other HHS grantees, sub-grantees, or affiliates.

To Facilitate Market Research Only, Subject to Modification 3

Dispense at Brick-and-Mortar Pharmacy with WAC Reimbursement

Gilead

Wholesale Distributor

Bottle

WAC

HUB

WAC

Donating Pharmacy

Claim

Invoice & Data

HHS

Wholesale Distributor & HUB Fees

To Facilitate Market Research Only, Subject to Modification

Invoice & Data

Wholesale Distributor Fees

Donating pharmacy dispenses out of customary, commercial inventory and obtains replacement bottles through usual channels.

Rx & Voucher

B o t t l e

Qualified Eligible Patient (QEP)Voucher

Invoice & Data R x

V o u c h e r

Buyer Bottle

Any Wholesale Distributor

Bottle

Payment

Payment

Dispense at Mail-Order Pharmacy with Reimbursement or Backfill

HUB

Mail-Order PharmacyHHS

Actual Acquisition Cost

Actual Acquisition Cost & Dispense Fee

Claim Or Bottle Request (Or Directly to Gilead)

Dispense and HUB Fees

To Facilitate Market Research Only, Subject to Modification

Invoice & Data

Data & Invoice or Bottle Request

Pharmacy dispenses out of customary, commercial inventory and obtains replacement bottles through usual channels or from Gilead.

Rx & Voucher

B o t t l e

QEPVoucher

R x

V o u c h e r

Any Wholesale Distributor

Payment

Bottle

In Lieu of Actual Acquisition Cost, Replacement Bottle

Dispense at Brick-and-Mortar Pharmacy with Backfill

HUB

Donating Pharmacy

HHS

Bottle

Bottle Request (Or Directly to Gilead)HUB Fees

To Facilitate Market Research Only, Subject to Modification

Invoice & Data

Data & Bottle Request

Pharmacy dispenses from customary, commercial inventory and obtains replacement bottles from Gilead.

Rx & Voucher

QEP

Voucher

Bottle

Rx & Voucher