OnePoint Patient Care, LLCv.Millennium Pharmaceuticals, Inc.Download PDFTrademark Trial and Appeal BoardApr 25, 201891228995 (T.T.A.B. Apr. 25, 2018) Copy Citation Trademark Trial and Appeal Board Electronic Filing System. http://estta.uspto.gov ESTTA Tracking number: ESTTA892436 Filing date: 04/25/2018 IN THE UNITED STATES PATENT AND TRADEMARK OFFICE BEFORE THE TRADEMARK TRIAL AND APPEAL BOARD Proceeding 91228995 Party Plaintiff OnePoint Patient Care, LLC Correspondence Address STAN SNEERINGER PEDERSEN & HOUPT 161 N CLARK STREET , SUITE 2700 CHICAGO, IL 60601 UNITED STATES Email: trademark@pedersenhoupt.com, ssneeringer@pedersenhoupt.com, cclaybough@pedersenhoupt.com Submission Testimony For Plaintiff Filer's Name Stanley C. Sneeringer Filer's email ssneeringer@pedersenhoupt.com, trademark@pedersenhoupt.com, mschmidt@pedersenhoupt.com Signature /Stanley C. Sneeringer/ Date 04/25/2018 Attachments Kevin Kirkland Affidavit.pdf(385533 bytes ) Kevin Kirkland Affidavit Exhs. 1-7.pdf(5153276 bytes ) Kevin Kirkland Affidavit Exhs. 8-11.pdf(2756313 bytes ) COLOR CODE REFERENCE CHART Time Pass Checklist: 1. Refer to Medication Administration Record (MAR) 2. Open the medication cart drawer for the resident’s meds 3. Locate the medications to be given at that time 4. Pull the OP® Card for the desired medication(s) 5. Remove the medication and place in med cup 6. Give medication and confirm it was administered properly 7. Initial the MAR verifying the medication(s) given 8. Place the OP® Card behind the existing medications 9. Repeat procedure until all needed meds are given 10. Report any errors or discrepancies to your supervisor *** These directions are intended to act as a guideline to ensure a safe and efficient Med Pass. Please follow all Med Pass guidelines and/or regulations as mandated and required by your community and refer to this Time Pass Checklist as a suggested reference only. *** 3006 S. Priest Drive Phone: (480) 240-1122 Tempe, AZ 85282 Fax: (480) 240-1123 7am - 10am Pink 8pm - 10pm Gray 11am - 1pm Yellow 11pm - 6am Purple 2pm - 4pm Green PRN Red 5pm - 7pm Orange Controlled Blue ALCCRC.AZ.0208 OPPC0000039 Opposition No. 91228995 Kirkland Affidavit Exh. 1 OPPC0000029 Opposition No. 91228995 Kirkland Affidavit Exh. 2 Your Patient. Your Time. Instant Prescription Access. Our versatile mobile application delivers an unprecedented level of information integration. Specifically designed to meet the unique needs of the hospice industry, OneConnectPoint simplifies the admission and medication ordering process to reduce the time clinicians spend dealing with pharmacy and ultimately increase the time they have available to spend caring for their patients. Our simple, seamless and secure technology allows our hospice partners to: • Quickly admit and update patients demographics and medication profiles • Place refill and new medication orders through our integrated e-Rx platform • Track the delivery status of a medication order • Verify medication orders real time against the hospice formulary, as well as screen for drug Interactions • Create a Prior Authorization for a non-formulary medication while placing an order • Ability to receive medication profiles from eMRs • Receive Notifications indicating Prior Authorizations and E-Rx orders pending approval For more information, please contact us: 866.771.OPPC (6772) info@oppc.com Visit OnePoint Patient Care online: www.oppc.com “OneConnectPoint is an invaluable tool. The app allows me to see what has been ordered for any patient, saving phone calls to nurses, the pharmacy and patients.” Connie, RN Hospice of the Valley - Arizona Download your FREE OneConnectPoint™ App today Apple, the Apple logo, iPad, are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google Inc. OPPC0000030 Opposition No. 91228995 Kirkland Affidavit Exh. 3 Phone: 866.771.OPPC (6772) Web: onepointpatientcare.com Our versatile mobile app delivers an unprecedented level of information integration. It streamlines the process so data is entered only once for your patients’ admission, prescription ordering and clinical management needs. You receive real-time updates to track orders, changes and prescription proile information right from your Windows, Apple, Android device or your PC. OUR SIMPLE, SEAMLESS AND SECURE TECHNOLOGY PLATFORMS ALLOW YOU TO: Your Patient. Your Time. Instant Prescription Access. INTRODUCING ONEPOINT PATIENT CARE’S MOBILE APPLICATION. “The Patient Care App is an invaluable tool. The app allows me to see what has been ordered for any patient, saving phone calls to nurses, the pharmacy and patients.” CONNIE, RN HOSPICE OF THE VALLEY – ARIZONA “ I can now order medications, proile orders for future dispensing and check on order status, all on my schedule, from a single, integrated app.” AMY, RN MANAGER IU HEALTH VNA HOSPICE – INDIANA Download your FREE Patient Care Mobile App today at https://mobile.oppc.com ORDER RECEIVED Save time and money with instant patient information access Take control of the ordering experience Know the status of the order in real time Issue prior authorizations Make informed clinical medication decisions Use OnePointRx to see therapeutic alternative considerations Simplify ordering and proiling information for new orders and reills, including controlled substances OPPC0000063 Opposition No. 91228995 Kirkland Affidavit Exh. 3 We’re a national hospice pharmacy that owns & controls our own pharmacies utilizing our exclusive Rx AccuTrack® quality control process. We’re employee-owned and report directly to our hospice partners and their patients, not shareholders or private equity investors. Our pharmacists customize preferred drug lists (PDLs) and provide formulary/PDL management programs speciic to each hospice we serve. As an integrated pharmacy & PBM, admitting patients and placing medication orders is just one easy phone call away. We’re technology leaders providing and enabling e-Prescribing for controlled substances, mobile tools and real-time data exchange. Our exclusive reporting system, OnePointRx™ gives you the tools to completely align your clinical objectives with inancial goals and benchmarks. Dispensing & delivery directly from OnePoint owned community pharmacies Same-day and next-day delivery options or utilize our national mail order capabilities Pharmacy beneits management services exclusively for hospice To learn more, call us at 866.771.OPPC (6772) or email sales@oppc.com www.onepointpatientcare.com Experience the difference when patients come first. We understand what is important to you and your patients. OPPC0000003 Opposition No. 91228995 Kirkland Affidavit Exh. 4 OPPC0000010 Opposition No. 91228995 Kirkland Affidavit Exh. 4 OPPC0000011 Opposition No. 91228995 Kirkland Affidavit Exh. 4 OPPC0000012 Opposition No. 91228995 Kirkland Affidavit Exh. 4 OPPC0000013 Opposition No. 91228995 Kirkland Affidavit Exh. 4 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 1 Partnering for Premier Pharmacy Services XYZ Hospice Month XX, 2017 OPPC0000071 Opposition No. 91228995 Kirkland Affidavit Exh. 5 2 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint • The OnePoint Difference • A Solution That Adds Up • Transition & Account Management • Next Steps Agenda OPPC0000072 Opposition No. 91228995 Kirkland Affidavit Exh. 5 3 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint The OnePoint Difference OPPC0000073 Opposition No. 91228995 Kirkland Affidavit Exh. 5 • Daily ADC of Over 30,000 • Processing Over 200,000 Rx’s/month • Nationwide Dispensing and Delivery Capabilities What Can One Do For You? 4 We’re unique in that we’re the only national hospice pharmacy that truly offers the full continuum of pharmacy services. Our hospice partners have the ability to select any combination of pharmacy services without ever having to change providers. 4 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint OPPC0000074 Opposition No. 91228995 Kirkland Affidavit Exh. 5 5 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 4. In 2005, rebranded as OnePoint Patient Care under new ownership 2. Began serving Arizona hospices in 1986 3. In 1995, consolidated into a single pharmacy, focused on hospice 1. Founded in 1965 as Professional Pharmacy 5. Began serving Las Vegas hospices in 2007 as our first expansion market 6. In 2008, continued national expansion by serving OK, FL, and IL hospices 7. Launched Clinical Consulting and hospice- only PBM capabilities in 2008 8. Opened our Vancouver, WA pharmacy in 2012 9. In 2014, expanded to Detroit, MI 10. In 2015, began serving Colorado from our new Denver pharmacy 11. In 2015, introduced new logo and tagline 12. Today we serve over 200 programs and over 30,000 patients/day in 26 states and counting OPPC Locations OPPC Serviced OnePoint’s History OPPC0000075 Opposition No. 91228995 Kirkland Affidavit Exh. 5 6 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint OnePoint Proudly Serves Many of the Nation’s Leading Hospices OPPC0000076 Opposition No. 91228995 Kirkland Affidavit Exh. 5 7 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint Attentive, Flexible & Forward Thinking Technology Leadership Scale Full Suite of Solut ions Privately Ow ned & Operated Act ive Account Management EMR Integrat ion Adaptability Flexibility Customizat ion Retent ion Low er Cost Solut ions OPPC0000077 Opposition No. 91228995 Kirkland Affidavit Exh. 5 8 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint We Embed and Promote a Superior Service Culture in All That We Do Professionalism, personal accountability and integrity are at the core of who we are and what we do, every hour of every day • Privately held • Promotion and recognition of customer service heroes – Gifts and financial rewards for service excellence – Caught in the Act programs where peers can recognize peers • Overarching message of “Patient First” • Mission statements are on each computer terminal – Provide our patients, their caregivers and family members with the highest quality of care, reliability and support while dispensing clinical advice, medications and delivery services. OPPC0000078 Opposition No. 91228995 Kirkland Affidavit Exh. 5 9 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint A Solution That Adds Up OPPC0000079 Opposition No. 91228995 Kirkland Affidavit Exh. 5 10 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint OnePoint’s Solutions Portfolio Creates the Most Flexible Service Model for Hospice Hospice Insight OnePoint Solut ions Superior Outcomes, Profitability & Options Greater control in a continually changing environment An adaptive service model designed to meet unique hospice needs Better patient outcomes achieved with profitability & control OPPC0000080 Opposition No. 91228995 Kirkland Affidavit Exh. 5 11 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint Hospices Face More Challenges Than Ever Before Hospice Challenges: • Industry Consolidation • Need To Control Costs • Reduced Reimbursement • Threat Of Medicare Carve-In • Increasing Regulatory Burden • More Frequent Audits • Need For Continued Profitable Growth • Recruitment Of Quality Nurses And Staff Hospice Insight OPPC0000081 Opposition No. 91228995 Kirkland Affidavit Exh. 5 12 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint As a PBM we adjudicate claims, manage custom formularies and maintain a comprehensive network of pharmacies for our partners to choose from. We own and operate eight regional hospice-dedicated pharmacies that can ship medications next day to hospice patients nationally, regardless of their location. Leveraging our eight regional hospice-dedicated pharmacies, hospices and their patients benefit greatly from unparalleled door-to-door delivery service that no other hospice pharmacy can provide. We provide our hospice partners with 24-hour access to state-of-the-art tools, information and resources to successfully navigate the every-changing and demanding regulatory and compliance environment. OnePoint Solut ions Solutions that Allow Hospice to Choose What They Need OPPC0000082 Opposition No. 91228995 Kirkland Affidavit Exh. 5 13 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint Concierge PBM We know that no two hospices are the same, so we act accordingly • Preferred drug list designed uniquely for your hospice • Flexible prior authorization processes that work for your hospice • 65,000 network pharmacies, overseen by a hospice expert • Fully transparent pricing models including fee-for-service, per diem & others • Fully compliant drug utilization & compliance reporting • Clinical advocates to ensure most cost effective therapies OnePoint Solut ions OPPC0000083 Opposition No. 91228995 Kirkland Affidavit Exh. 5 14 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint A Custom Preferred Drug List Created with Your Clinical Team, Managed By OnePoint OnePoint Solut ions OPPC0000084 Opposition No. 91228995 Kirkland Affidavit Exh. 5 15 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint Next Day Valet: Mail Order OnePoint Solut ions OPPC0000085 Opposition No. 91228995 Kirkland Affidavit Exh. 5 16 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint Next Day Valet: Mail Order We create a positive, memorable service experience with each call • Reliability & quality of a stable hospice pharmacy organization • Next day or second day delivery by professional couriers • A single phone call is all it takes (Integrated PBM & Pharmacy) • Clinical knowledge (every pharmacist is a hospice pharmacist) • Deep stock of hospice medications • Every employee goes through hospice training • Open 365 days a year • Specialty compounds (e.g., phenobarb suppositories) as needed • Online ordering tools & reporting (C2 & other controlled substances) OnePoint Solut ions OPPC0000086 Opposition No. 91228995 Kirkland Affidavit Exh. 5 17 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint Direct Express: Local Service A hospice pharmacy that cares for your patients as much as you do • Providing over 30 years of local hospice pharmacy services • Direct pharmacy contact with each call • Same day deliveries, including STATs – 93% of deliveries are made in under 4 hours • 24 hour clinical advice, support & therapeutic recommendations • Our Rx Accutrack® quality control process ensures a 99.997% accuracy rate • Custom compounds for hospice we provide • Unit-dosing & pre-filled syringes • All staff members have access to full patient profile & dispensing history at their fingertips OnePoint Solut ions OPPC0000087 Opposition No. 91228995 Kirkland Affidavit Exh. 5 18 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint Integrated Care Solutions Mobile & Desktop App Integrat ion w ith Hospice Management Systems • Tailored to Hospice Needs • Enable CoP Compliance • Puts cost management tools in hospices’ hands • Online Reporting • Patient profile management • Refill orders • ADT interfaces • New customer on-boarding • CR8358 Data OnePoint Solut ions OPPC0000088 Opposition No. 91228995 Kirkland Affidavit Exh. 5 19 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint OneConnectPoint™ Reporting Provides Real-Time Access to Patient Data • User name & password protected; administrative rights granted to each hospice • 24-hour web-enabled access, as well as automatic daily, weekly, or monthly emails • Hospices have ability to customize each report & view relevant dispensing data • All reports can be exported to Excel, Adobe Acrobat and Word • Administrative Reports like “Top Patients by Drug Spend” & “Expiring CII Prescriptions” • Clinical Reports like “TIER Report” & “Deprescribing Options Report” • Trend Reports like “Monthly Financial Trend for Team” OnePoint Solut ions OPPC0000089 Opposition No. 91228995 Kirkland Affidavit Exh. 5 20 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint OneConnectPoint: Tools & Features OnePoint Solut ions OPPC0000090 Opposition No. 91228995 Kirkland Affidavit Exh. 5 21 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint CMS CR 8358 OnePoint has committed to ADT EMR interfacing with all major vendors • OnePoint has a report available via OneConnectPoint™ with ALL required detail on a line item basis per fill – Non-Injectable Drugs (including compound ingredients): NDC – Injectable Drugs: HCPCS • Required detail can be imported directly into any EMR system • Report is in an Excel format (.csv) • OnePoint provides EMR data export support • Eliminates and/or minimizes manual data entry by hospice staff OnePoint Solut ions OPPC0000091 Opposition No. 91228995 Kirkland Affidavit Exh. 5 22 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint Benefits to Hospice • Clinical knowledge produces better patient outcomes/symptom management • Streamlined processes & high accuracy rates yield higher hospice staff productivity & increased staff retention • Provides competitive advantage increasing referrals • Greater hospice control ensures compliance Superior Outcomes, Profitability & Control OPPC0000092 Opposition No. 91228995 Kirkland Affidavit Exh. 5 23 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint Transition & Account Management OPPC0000093 Opposition No. 91228995 Kirkland Affidavit Exh. 5 24 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint All Solutions Enjoy Active Transition & Account Management • We take full responsibility for seamlessly managing the transition process – Project Management – Coordination with EMR Vendors – Physician & Nurse Training – On site support during “go live” period • Account manager assigned to each partner to: – Assist in solving any day-to-day issues – Perform quarterly reviews – Provide retrospective analysis for all aspects of service • Our experience managing hundreds of transitions ensures your peace of mind Transit ion & Account Management OPPC0000094 Opposition No. 91228995 Kirkland Affidavit Exh. 5 25 © 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint The OnePoint Difference One Call One Partner One Leader One Price One Resource One Commitment One Competit ive Advantage OPPC0000095 Opposition No. 91228995 Kirkland Affidavit Exh. 5 OPPC0000017 Opposition No. 91228995 Kirkland Affidavit Exh. 6 OPPC0000018 Opposition No. 91228995 Kirkland Affidavit Exh. 6 OPPC0000019 Opposition No. 91228995 Kirkland Affidavit Exh. 6 OPPC0000020 Opposition No. 91228995 Kirkland Affidavit Exh. 6 OPPC0000021 Opposition No. 91228995 Kirkland Affidavit Exh. 6 OPPC0000022 Opposition No. 91228995 Kirkland Affidavit Exh. 6 OPPC0000023 Opposition No. 91228995 Kirkland Affidavit Exh. 6 OPPC0000024 Opposition No. 91228995 Kirkland Affidavit Exh. 6 OPPC0000025 Opposition No. 91228995 Kirkland Affidavit Exh. 6 1 OnePoint Patient Care Uncovered Pharmacy Drugs & Services (Medications not financially covered by Hospice) Frequently Asked Questions (FAQs) 1) What is OnePoint Patient Care? OnePoint Patient Care is the nation’s leading locally-based hospice pharmacy that dispenses and delivers hospice medications in each market we serve. We deliver hospice covered medications direct to your door, and as an added convenience to our patients, we offer the ability for you to order and receive non-hospice covered medications as well. Our clinical professionals are dedicated to and focused on the unique needs of hospice patients by providing a thorough clinical review and complete medication profiling for a patient’s entire drug regimen. OnePoint’s attentive Customer Care Specialists (delivery personnel) help ensure timely and accurate delivery of all medications. Our goal is to provide our patients, their caregivers and family members with the highest quality of care, reliability, and support while dispensing and delivering medications, and providing clinical advice. 2) What does the term “hospice covered medications” mean? The Medicare hospice benefit covers medications needed to treat symptoms that occur as a result of a hospice patient’s terminal illness and related conditions. Generally, your hospice provider will order medications for you, and we will deliver them direct to your home. All new orders are delivered same day. All refill orders are delivered next day. Medications for a condition not related to your terminal illness – a cholesterol lowering medication for example – is typically not “financially” covered by your hospice because it is not covered by the Medicare hospice benefit. 3) What does the term “non-hospice covered” or “non-related” medications mean? Medications not directly related to the management of symptoms that occur as a result of hospice patients’ terminal diagnosis and other related conditions are considered non- hospice covered medications under the Medicare hospice benefit, and therefore are not financially covered by your hospice provider. Although these medications may not be paid for by your hospice provider, they may be a medication that you or your loved one wishes to continue taking. If this is the case, we offer you the convenience of ordering your non-covered medications through our hospice pharmacy, we will deliver them directly to your doorstep, and we will gladly bill your existing private insurance plan and charge the remaining balance or your co-pay to a credit card. If the hospice patient does not have a credit card, we will also accept credit cards for a primary care giver or family member. NHM.FAQ.AZ.051209 OPPC0000047Opposition No. 91228995 Kirkland Affidavit Exh. 7 2 4) Why should I use OnePoint Patient Care to provide my non-hospice covered medications? OnePoint Patient Care is a complete pharmacy service provider. We dispense and deliver both covered and non-covered medications for our hospice patients. If you did not choose to order your non-hospice covered medications through OnePoint Patient Care, it’s likely you or a loved one would have to call the order into your local neighborhood retail pharmacy, wait for the medications to be dispensed and then go to the pharmacy to pick-up the medications yourself. By using OnePoint, the medications are ordered by your hospice nurse and delivered to your doorstep with your hospice medications. 5) Is “convenience” the only advantage to using OnePoint for my non-hospice covered medications? NO! A more important benefit of having OnePoint Patient Care dispense your hospice covered and non-hospice covered medications is the complete medication screening we offer for your entire medication regimen. It can be potentially unsafe for you to use multiple pharmacies to provide your medications because each pharmacy may not have access to information regarding your entire medication profile. By having OnePoint as your complete pharmacy service provider, we profile your entire medication regime, screen for drug-to-drug interactions, screen for duplicate therapies and medication allergies to ensure the absolute highest quality of clinical and therapeutic outcomes for you. 6) I’m completely satisfied with my neighborhood pharmacy. You may be “satisfied” with your current pharmacy – but we promise, you will be “thrilled” by the level of support, service and expertise you receive from OnePoint Patient Care as your pharmacy. - Does your existing neighborhood pharmacy deliver your medications direct to your home? We do! - Does your current pharmacy screen 100% of your prescriptions and medications before your order is dispensed and filled? We do! - Does your current pharmacy discuss any medication related issues they find with your nurse or physician before your order is dispensed and filled? We do! 7) Is there a price difference with OnePoint Patient Care? It’s extremely unlikely. If your medication expenses (co-pays and deductibles) are currently covered under a nationally recognized and commercially available insurance program, then it’s very likely we can bill the same insurance programs as your pharmacy does today. Therefore, your medication co-pays and deductibles with OnePoint Patient Care will be identical to the co-pays and deductibles you are paying today. If a particular medication is NOT covered by your insurance provider, and you are required to pay the full retail price for your medications, then the OnePoint Patient Care medication costs will be priced competitively with the pharmacy you currently use today. 8) Do I have to pay for the delivery service? Delivery fees DO NOT apply for orders that are placed, filled and delivered with hospice- covered medications. Our delivery service is offered free of charge to our hospice NHM.FAQ.AZ.051209 OPPC0000048Opposition No. 91228995 Kirkland Affidavit Exh. 7 3 patients that are also receiving hospice-covered medications with their non-hospice medications delivery. A delivery convenience fee of $10.00 WILL apply for orders that are placed, filled and delivered WITHOUT any hospice-covered medications. 9) How are medications ordered from OnePoint Patient Care? Your medications are ordered by your hospice nurse. The hospice nurse will contact OnePoint Patient Care to place your medication order for you, on your behalf. You simply need to communicate your medication needs to your hospice nurse directly and ensure they have a copy of your most updated pharmacy prescription(s). 10) Who do I call if I have any questions about my prescription/order? If you have any questions about your medications, please contact your hospice nurse directly. They will be happy to answer any questions or comments you have about your order and expected delivery. 11) How often can I have my medications delivered? Your medications will be delivered in daily cycles directly to your home. We require that a designated adult or primary caregiver sign for the medications on your behalf to ensure safe acceptance of your order at your home. As your medications begin to run low, please notify your hospice nurse in advance to ensure that refills are available and delivered in a timely manner. 12) What if my insurance coverage or my credit card information changes for my non-hospice medications? Simply inform your hospice nurse of any insurance or credit card information changes. Your hospice nurse will communicate such changes directly to our pharmacy. 13) Does OnePoint Patient Care accept my current insurance plan? OnePoint Patient Care accepts most common nationally recognized prescription insurance programs. As a matter of fact, we accept so many insurance programs that it’s difficult to list each one individually. It’s easier to tell you the insurance programs we unfortunately can not accept today. They are: A) Veterans Administration Health Benefits recipients B) MediSun 14) How do I manage changes to my medication regimen? We understand that it’s possible for changes to occur in your medication regimen (i.e. changes in your prescription medication type, dosage amounts, dosage intervals, etc.) If such changes occur, simply inform your hospice nurse of any medication regimen changes. Your hospice nurse will communicate such changes directly to our pharmacy. 15) Do you provide “over the counter” or OTC medications? NHM.FAQ.AZ.051209 OPPC0000049Opposition No. 91228995 Kirkland Affidavit Exh. 7 4 Yes we do. You can order the same over the counter (OTC) medications you currently purchase today at your local neighborhood pharmacy. We may not always carry the brand name of medication that you use. If this is the case, please notify your hospice nurse and they will gladly work with our pharmacy to attempt to accommodate your request. 16) Are your prices competitive with my local neighborhood pharmacy? Yes. Our medication prices are competitively priced with other pharmacies. In some cases, there are large retail chains (Walmart, Meijer, Frys) that offer very aggressive pricing on some medications because they purchase in bulk and are able to maximize their purchasing power. We’re not always going to be able to match everyone’s price – but we will always be competitively priced. If you ever have a question about the price of our medications, please notify your hospice nurse and they will be happy to work with our pharmacy to compare our prices with you. 17) Can I pay cash for my medications? No, we only accept credit cards for non-hospice covered medications. 18) How do I use a credit card to make payments to OnePoint Patient Care? It’s very easy to set-up a credit card account with OnePoint Patient Care. All you need to do is: A) Complete a copy of the Credit Card Authorization Form. You can get one from your hospice nurse. B) Provide the completed form to your hospice nurse or fax it directly to OnePoint Patient Care at 480-240-1112, and C) We will set-up your account and begin delivering your medications to you! 19) Will I receive a medication bill/invoice monthly? What will it look like? Patients will receive a monthly statement in the mail that will indicate the medications ordered and the charges that have been made to the credit card for such medications. 20) How do I get started using OnePoint Patient Care for my “non-hospice covered” pharmacy needs? It’s as easy as 1-2-3: 1) See your hospice nurse or a hospice representative for more information about using OnePoint Patient Care. 2) Complete a copy of the Credit Card Authorization Form. 3) Provide the completed form to your hospice nurse and they will fax it directly to OnePoint Patient Care at 480-240-1112. 21) Who do I call if I have questions about OnePoint Patient Care? Simply contact your hospice nurse if you have questions about OnePoint Patient Care. Your hospice nurse will communicate such questions directly to our pharmacy and will endeavor to get answers for you quickly. 22) Is my patient information and privacy protected with OnePoint Patient Care? NHM.FAQ.AZ.051209 OPPC0000050Opposition No. 91228995 Kirkland Affidavit Exh. 7 5 Yes. All of your information is kept strictly confidential and protected by OnePoint Patient Care. We are HIPAA compliant, meaning we adhere to the strict government standards for patient privacy protection. HIPAA stands for The Health Insurance Portability and Accountability Act of 1996. For more information on your privacy rights and HIPAA, please feel free to contact: The U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 Telephone: 202-619-0257 Toll Free: 1-877-696-6775 Website: www.hhs.gov 23) How can I learn more about OnePoint Patient Care? Visit us online at www.oppc.com. NHM.FAQ.AZ.051209 OPPC0000051Opposition No. 91228995 Kirkland Affidavit Exh. 7 OnePoint Patient Care Explanation of Pharmacy Services Dear Patient, Family Member or Primary Caregiver: OnePoint Patient Care is your hospice provider’s preferred pharmacy. We work closely with the hospice agency to provide for all the medications covered by the hospice under the hospice benefit. As a service to our hospice partners and their patients, OnePoint Patient Care is pleased to offer hospice patients the opportunity to receive their uncovered/non-hospice medications from OnePoint Patient Care. Specifically, these are medications that the hospice has determined the patient needs but that will not be financially covered by your hospice. Enclosed is all necessary paperwork you need to read and complete should you wish to have OnePoint Patient Care dispense and deliver your medications that are not financially covered by the hospice. The forms include: • Frequently Asked Questions • Medication Authorization & Patient Insurance Form • Credit Card Authorization Form • Sample Billing Statement It is important that you or the financially responsible party understand the conditions of participation in this program. 1. Only hospice nurses or personnel may call in or fax new orders or refills to OnePoint Patient Care for uncovered/non-hospice medications (refill requests by patients or their family will not be allowed). 2. Uncovered/non-hospice medications will be delivered at the same time the covered hospice medications are delivered; except a) If a separate delivery is required to deliver the uncovered/non-hospice medications because there were no hospice medications to be delivered or there was an insurance processing delay due to prior authorization by the patient’s insurance company, during normal business hours, there will be a $10 convenience fee charged to the patient. b) For orders placed and filled outside the Pharmacy normal business hours, the Pharmacy will charge an after hours/on call fee of $65. 3. The Pharmacy’s normal business hours are: Monday - Friday 8am – 8pm, Saturday, Sunday and Holidays, 8am – 6pm. 4. OnePoint Patient Care will only fill uncovered/non-hospice medications for those patients who have filled out all the paperwork and provided us with a valid credit card to be billed. All of your co-pay amounts for uncovered/non-hospice medications, along with any convenience fee, will be billed to the designated credit card PRIOR to leaving the pharmacy. 5. Any uncovered/non-hospice medications ordered that are NOT covered by your third party insurance will NOT be processed at OnePoint Patient Care without prior authorization. We will contact your physician for a prior authorization. If we are unable to get the prior authorization, we will contact your hospice nurse with cost information and request your approval to bill you directly for that medication. 6. If the credit card cannot be billed, the uncovered/non-hospice medications will not be sent. 7. Each month, a detailed statement will be sent detailing the medications provided by OnePoint Patient Care, the cost of the medications and the amount charged to your designated credit card. To get started, the patient or financially responsible party should sign the enclosed documents and return to your hospice representative. Thank you for choosing OnePoint Patient Care for your pharmacy needs. NHM.OLTP.052209 OPPC0000053 Opposition No. 91228995 Kirkland Affidavit Exh. 7 OnePoint Patient Care Medication Credit Card Authorization Form OnePoint Patient Care will accept credit cards as payment for your medications. We accept Visa, MasterCard, Discover Card and American Express. We will charge the amount due on or after the 1st day of every month and mail you a receipt with your statement. We will charge your credit card for any remaining balance once you leave the facility that we service. This might result in your credit card being charged twice in one month. Patient Name: _________________________________________________ Customer Number: _____________________________________________ Credit Card Holder Name: _______________________________________ Credit Card Billing Address: _____________________________________ _____________________________________ Credit Card Number: ________-________-________-________ Exp Date: ______________ I authorize OnePoint Patient Care to charge my credit card upon dispensing of each order. I understand that this is an optional service provided and that either party may cancel the credit card authorization Agreement at any time. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) _______________________________ (Print Name) 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 Email: Accounting-AR@oppc.com OPPC0000031 Opposition No. 91228995 Kirkland Affidavit Exh. 8 PATIENT NAME: _____________________________________ AUTHORIZATION TO PAY BENEFITS TO PROVIDER: I hereby authorize OnePoint Patient Care to request on my behalf all public and private insurance benefits for products and services supplied to me by OnePoint Patient Care. I further authorize payment for such supplies and/or services to be made directly to: OnePoint Patient Care, 3006 S. Priest Dr. Tempe, AZ 85282. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) PATIENT RELEASE FORM: I hereby authorize any holder of medical and/or insurance information about me to disclose such information to OnePoint Patient Care. I further authorize OnePoint Patient Care to disclose any medical and/or insurance information concerning me in its possession to other professional personnel involved with my care, and to any insurer or other third-party payer who may be responsible for payment of OnePoint Patient Care services. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) FINANCIAL RESPONSIBILITY: So that OnePoint Patient Care may provide me with pharmaceutical products and services prescribed by my physician, I agree that I am responsible to OnePoint Patient Care for payment of all such products and services (one time set up patient authorized). In addition, I agree that I will inform OnePoint Patient Care promptly of any change(s) in my status. This includes, but is not limited to, change in my address, being admitted to a hospital or other nursing facility, or any change that affects third party payment or my ability to pay for products and services rendered by OnePoint Patient Care. OnePoint Patient Care charges a service charge for outstanding balance at .015% of previous balance due. Responsible party agrees to pay all charges. _______________________________ _____________________ (Financial Representative Signature) (Date) _______________________________ _____________________ (Patient Signature) (Date) _______________________________ _____________________ (Care Home) (Date) TCPA EXPRESS CONSENT NOTICE: You agree, in order for us to service our account or to collect any amounts you may owe, we may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or e-mails, using any e-mail address you provide to us. Methods of contact may include using pre-recorded/artificial voice messages and/or use of an automatic dialing device, as applicable. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 Email: Accounting-AR@oppc.com OPPC0000032 Opposition No. 91228995 Kirkland Affidavit Exh. 8 NEW PATIENT INFORMATION FORM Resident Information Name: ___________________________________________ DOB: ____________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: _____________________________ Allergies: ____________________ Social Security #: _________________________________ Doctor Information Doctor Name: __________________________________________________________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: ______________________________ Fax: _______________________ Billing Information (address to send statements) Bill to: _____________________________________ Phone: _______________ Address: _____________________________________________________________ City: ____________________________ State: _____ Zip Code: ____________ Prescription Insurance Information (please include copy of card, front and back) Insurance Name: ______________________________________________________ Phone: ____________________ Address: _____________________________ ID#: _______________________ Group #: _____________________________ Please sign if no prescription coverage: __________________________________ *** OnePoint Patient Care will invoice your account monthly *** 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 OPPC0000033 Opposition No. 91228995 Kirkland Affidavit Exh. 8 NEW PATIENT INFORMATION FORM Resident Information Name: ___________________________________________ DOB: ____________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: _____________________________ Allergies: ____________________ Social Security #: _________________________________ Doctor Information Doctor Name: __________________________________________________________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: ______________________________ Fax: _______________________ Billing Information (address to send statements) Bill to: _____________________________________ Phone: _______________ Address: _____________________________________________________________ City: ____________________________ State: _____ Zip Code: ____________ Prescription Insurance Information (please include copy of card, front and back) Insurance Name: ______________________________________________________ Phone: ____________________ Address: _____________________________ ID#: _______________________ Group #: _____________________________ Please sign if no prescription coverage: __________________________________ *** OnePoint Patient Care will invoice your account monthly *** 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 OPPC0000034 Opposition No. 91228995 Kirkland Affidavit Exh. 8 NEW PATIENT INFORMATION FORM Resident Information Name: ___________________________________________ DOB: ____________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: _____________________________ Allergies: ____________________ Social Security #: _________________________________ Doctor Information Doctor Name: __________________________________________________________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: ______________________________ Fax: _______________________ Billing Information (address to send statements) Bill to: _____________________________________ Phone: _______________ Address: _____________________________________________________________ City: ____________________________ State: _____ Zip Code: ____________ Prescription Insurance Information (please include copy of card, front and back) Insurance Name: ______________________________________________________ Phone: ____________________ Address: _____________________________ ID#: _______________________ Group #: _____________________________ Please sign if no prescription coverage: __________________________________ *** OnePoint Patient Care will invoice your account monthly *** 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 OPPC0000035 Opposition No. 91228995 Kirkland Affidavit Exh. 8 PATIENT NAME: _____________________________________ AUTHORIZATION TO PAY BENEFITS TO PROVIDER: I hereby authorize OnePoint Patient Care to request on my behalf all public and private insurance benefits for products and services supplied to me by OnePoint Patient Care. I further authorize payment for such supplies and/or services to be made directly to: OnePoint Patient Care, 3006 S. Priest Dr. Tempe, AZ 85282. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) PATIENT RELEASE FORM: I hereby authorize any holder of medical and/or insurance information about me to disclose such information to OnePoint Patient Care. I further authorize OnePoint Patient Care to disclose any medical and/or insurance information concerning me in its possession to other professional personnel involved with my care, and to any insurer or other third-party payer who may be responsible for payment of OnePoint Patient Care services. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) FINANCIAL RESPONSIBILITY: So that OnePoint Patient Care may provide me with pharmaceutical products and services prescribed by my physician, I agree that I am responsible to OnePoint Patient Care for payment of all such products and services (one time set up patient authorized). In addition, I agree that I will inform OnePoint Patient Care promptly of any change(s) in my status. This includes, but is not limited to, change in my address, being admitted to a hospital or other nursing facility, or any change that affects third party payment or my ability to pay for products and services rendered by OnePoint Patient Care. OnePoint Patient Care charges a service charge for outstanding balance at .015% of previous balance due. Responsible party agrees to pay all charges. _______________________________ _____________________ (Financial Representative Signature) (Date) _______________________________ _____________________ (Patient Signature) (Date) _______________________________ _____________________ (Care Home) (Date) TCPA EXPRESS CONSENT NOTICE: You agree, in order for us to service our account or to collect any amounts you may owe, we may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or e-mails, using any e-mail address you provide to us. Methods of contact may include using pre-recorded/artificial voice messages and/or use of an automatic dialing device, as applicable. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 Email: Accounting-AR@oppc.com OPPC0000036 Opposition No. 91228995 Kirkland Affidavit Exh. 8 OnePoint Patient Care Medication Credit Card Authorization Form OnePoint Patient Care will accept credit cards as payment for your medications. We accept Visa, MasterCard, Discover Card and American Express. We will charge the amount due on or after the 1st day of every month and mail you a receipt with your statement. We will charge your credit card for any remaining balance once you leave the facility that we service. This might result in your credit card being charged twice in one month. Patient Name: _________________________________________________ Customer Number: _____________________________________________ Credit Card Holder Name: _______________________________________ Credit Card Billing Address: _____________________________________ _____________________________________ Credit Card Number: ________-________-________-________ Exp Date: ______________ I authorize OnePoint Patient Care to charge my credit card upon dispensing of each order. I understand that this is an optional service provided and that either party may cancel the credit card authorization Agreement at any time. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) _______________________________ (Print Name) 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 Email: Accounting-AR@oppc.com OPPC0000037 Opposition No. 91228995 Kirkland Affidavit Exh. 8 AUTHORIZATION FORM PATIENT NAME: _____________________________________ AUTHORIZATION TO PAY BENEFITS TO PROVIDER: I hereby authorize OnePoint Patient Care to request on my behalf all public and private insurance benefits for products and services supplied to me by OnePoint Patient Care. I further authorize payment for such supplies and/or services to be made directly to: OnePoint Patient Care, 3006 S. Priest Dr. Tempe, AZ 85282. ________________________________ ______________________ (Patient/Authorized Representative Signature) (Date) PATIENT RELEASE FORM: I hereby authorize any holder of medical and/or insurance information about me to disclose such information to OnePoint Patient Care. I further authorize OnePoint Patient Care to disclose any medical and/or insurance information concerning me in its possession to other professional personnel involved with my care, and to any insurer or other third-party payer who may be responsible for payment of OnePoint Patient Care services. ________________________________ _______________________ (Patient/Authorized Representative Signature) (Date) FINANCIAL RESPONSIBILITY: So that OnePoint Patient Care may provide me with pharmaceutical products and services prescribed by my physician, I agree that I am responsible to OnePoint Patient Care for payment of all such products and services (one time set up patient authorized). In addition, I agree that I will inform OnePoint Patient Care promptly of any change(s) in my status. This includes, but is not limited to, change in my address, being admitted to a hospital or other nursing facility, or any change that affects third party payment or my ability to pay for products and services rendered by OnePoint Patient Care. OnePoint Patient Care charges a service charge for outstanding balance at 15% of previous balance due. Responsible party agrees to pay all charges. __________________________________ _________________________ (Financial Representative Signature) (Date) __________________________________ _________________________ (Patient Signature) (Date) __________________________________ _________________________ (Assisted Living Community) (Date) 3006 S. Priest Drive Phone: (480) 240-1122 Tempe, AZ 85282 Fax: (480) 240-1123 ALAF.AZ.02.08 OPPC0000038 Opposition No. 91228995 Kirkland Affidavit Exh. 8 CREDIT CARD AUTHORIZATION FORM OnePoint Patient Care accepts credit cards as a form of payment for your medications. For your convenience, we accept Visa, MasterCard, Discover Card and American Express. We will charge the amount due on or after the 1st day of every month and mail you a receipt with your statement. Patient Name: ____________________________________ Pharmacy Account #: ______________________________ Card Holder Name: ________________________________ Credit Card Number: ________-________-________-________ Exp Date: ______________ I authorize OnePoint Patient Care to charge my credit card on or after the first day of every month for the total due on my account. I understand that this is an optional service provided and that either party may cancel the credit card authorization Agreement at any time. Signature of cardholder or authorized user: __________________________________ Date: __________________ 3006 S. Priest Drive Phone: (480) 240-1122 Tempe, AZ 85282 Fax: (480) 240-1123 ALCCAF.AZ.0608 OPPC0000041 Opposition No. 91228995 Kirkland Affidavit Exh. 8 NEW PATIENT INFORMATION FORM Resident Information Name: ___________________________________________ DOB: ___________ Address: _______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: _____________________________ Allergies: ____________________ Doctor Information Doctor Name: __________________________________________________________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: ______________________________ Fax: _______________________ Billing Information (address to send statements) Bill to: _____________________________________ Phone: _______________ Address: _____________________________________________________________ City: ____________________________ State: _____ Zip Code: ____________ Prescription Insurance Information (please include copy of card, front and back) Insurance Name: ______________________________________________________ Phone: ____________________ Address: _____________________________ ID#: _______________________ Group #: _____________________________ Please sign if no prescription coverage: __________________________________ *** Credit card information is REQUIRED for all hospice patients (on and off service) *** *** OnePoint Patient Care will bill your credit card monthly *** 3006 S. Priest Drive Phone: (480) 240-1122 Tempe, AZ 85282 Fax: (480) 240-1123 ALNPIF.AZ.0208 OPPC0000043 Opposition No. 91228995 Kirkland Affidavit Exh. 8 OnePoint Patient Care Uncovered/Non-Hospice Medication Authorization Form Patient Name: _______________________________ Date of Birth: ____________ Authorization of Financial Responsibility: So that OnePoint Patient Care may provide me with pharmaceutical products (and delivery of such products) and services prescribed by my physician, I agree that I am responsible to OnePoint Patient Care for payments of all such products, delivery charges and services. In addition, I agree that I will inform OnePoint Patient Care promptly of any change(s) in my status. This includes, but is not limited to, change in my address, being admitted to a hospital or other nursing facility, or any change that affects third party payment or my ability to pay for products (including delivery charges) and services rendered by OnePoint Patient Care. I represent to OnePoint Patient Care that I have authorized the hospice to order products and services from OnePoint Patient Care. Authorization to Pay Benefits: I hereby authorize OnePoint Patient Care to request on my behalf all public and private insurance benefits for products, delivery charges and services supplied to me by OnePoint Patient Care. I further authorize payment for such supplies and/or services to be made directly to: OnePoint Patient Care, 3006 S. Priest Dr. Tempe, AZ 85282. Authorization to Release Information: I hereby authorize any holder of medical and/or insurance information about me to disclose such information to OnePoint Patient Care. I further authorize OnePoint Patient Care to disclose any medical and/or insurance information concerning me in its possession to other professional personnel involved with my care, and to any insurer or other third-party payer who may be responsible for payment of OnePoint Patient Care services. Insurance Information **A copy of the front and back of your insurance card(s) MUST be attached** Insurance Name: _____________________________________________________________ Address: ___________________________________________________________________ Phone: _______________________ ID#: ___________________________ Group#: _______________________ BIN#: ___________________________ Please initial if no insurance coverage: _______ Financial Responsible Party Bill to: ___________________________________ Phone: ___________________________ Address: _______________________ City: __________________ State: _____ ZIP:_________ By signing below, Patient/Responsible Party acknowledges that he/she has received, read, understands and agrees to the terms of the "Explanation of Pharmacy Services" letter. __________________________________________ __________________________ Patient/Authorized Representative Signature Date 3006 S. Priest Drive Phone: (480) 240-1111 Tempe, AZ 85282 Fax: (480) 240-1112 NHM.AUTH.AZ.050509 OPPC0000045Opposition No. 91228995 Kirkland Affidavit Exh. 8 OnePoint Patient Care Uncovered/Non-Hospice Medication Credit Card Authorization Form OnePoint Patient Care will accept credit cards as payment for medications not financially covered by your hospice. We accept Visa, MasterCard, Discover Card and American Express. We will charge the amount due upon dispensing of each order. Patient Name: _____________________________________ Patient Date of Birth: _____________________________________ Credit Card Holder Name: ____________________________ Credit Card Billing Address: ____________________________ City: ____________________________ State: ____________________________ Zip: ____________________________ Phone: ____________________________ Credit Card Number: ________-________-________-________ Exp Date: ______________ I authorize OnePoint Patient Care to charge my credit card upon dispensing of each order. I understand that this is an optional service provided and that either party may cancel the credit card authorization Agreement at any time. Signature of cardholder or authorized user: __________________________________ Date: __________________ 3006 S. Priest Drive Phone: (480) 240-1111 Tempe, AZ 85282 Fax: (480) 240-1112 NHM.CCAUTH.AZ.031109 OPPC0000046Opposition No. 91228995 Kirkland Affidavit Exh. 8 1 OnePoint Patient Care Uncovered Pharmacy Drugs & Services (Medications not financially covered by Hospice) Frequently Asked Questions (FAQs) 1) What is OnePoint Patient Care? OnePoint Patient Care is the nation’s leading locally-based hospice pharmacy that dispenses and delivers hospice medications in each market we serve. We deliver hospice covered medications direct to your door, and as an added convenience to our patients, we offer the ability for you to order and receive non-hospice covered medications as well. Our clinical professionals are dedicated to and focused on the unique needs of hospice patients by providing a thorough clinical review and complete medication profiling for a patient’s entire drug regimen. OnePoint’s attentive Customer Care Specialists (delivery personnel) help ensure timely and accurate delivery of all medications. Our goal is to provide our patients, their caregivers and family members with the highest quality of care, reliability, and support while dispensing and delivering medications, and providing clinical advice. 2) What does the term “hospice covered medications” mean? The Medicare hospice benefit covers medications needed to treat symptoms that occur as a result of a hospice patient’s terminal illness and related conditions. Generally, your hospice provider will order medications for you, and we will deliver them direct to your home. All new orders are delivered same day. All refill orders are delivered next day. Medications for a condition not related to your terminal illness – a cholesterol lowering medication for example – is typically not “financially” covered by your hospice because it is not covered by the Medicare hospice benefit. 3) What does the term “non-hospice covered” or “non-related” medications mean? Medications not directly related to the management of symptoms that occur as a result of hospice patients’ terminal diagnosis and other related conditions are considered non- hospice covered medications under the Medicare hospice benefit, and therefore are not financially covered by your hospice provider. Although these medications may not be paid for by your hospice provider, they may be a medication that you or your loved one wishes to continue taking. If this is the case, we offer you the convenience of ordering your non-covered medications through our hospice pharmacy, we will deliver them directly to your doorstep, and we will gladly bill your existing private insurance plan and charge the remaining balance or your co-pay to a credit card. If the hospice patient does not have a credit card, we will also accept credit cards for a primary care giver or family member. NHM.FAQ.AZ.051209 OPPC0000047Opposition No. 91228995 Kirkland Affidavit Exh. 8 2 4) Why should I use OnePoint Patient Care to provide my non-hospice covered medications? OnePoint Patient Care is a complete pharmacy service provider. We dispense and deliver both covered and non-covered medications for our hospice patients. If you did not choose to order your non-hospice covered medications through OnePoint Patient Care, it’s likely you or a loved one would have to call the order into your local neighborhood retail pharmacy, wait for the medications to be dispensed and then go to the pharmacy to pick-up the medications yourself. By using OnePoint, the medications are ordered by your hospice nurse and delivered to your doorstep with your hospice medications. 5) Is “convenience” the only advantage to using OnePoint for my non-hospice covered medications? NO! A more important benefit of having OnePoint Patient Care dispense your hospice covered and non-hospice covered medications is the complete medication screening we offer for your entire medication regimen. It can be potentially unsafe for you to use multiple pharmacies to provide your medications because each pharmacy may not have access to information regarding your entire medication profile. By having OnePoint as your complete pharmacy service provider, we profile your entire medication regime, screen for drug-to-drug interactions, screen for duplicate therapies and medication allergies to ensure the absolute highest quality of clinical and therapeutic outcomes for you. 6) I’m completely satisfied with my neighborhood pharmacy. You may be “satisfied” with your current pharmacy – but we promise, you will be “thrilled” by the level of support, service and expertise you receive from OnePoint Patient Care as your pharmacy. - Does your existing neighborhood pharmacy deliver your medications direct to your home? We do! - Does your current pharmacy screen 100% of your prescriptions and medications before your order is dispensed and filled? We do! - Does your current pharmacy discuss any medication related issues they find with your nurse or physician before your order is dispensed and filled? We do! 7) Is there a price difference with OnePoint Patient Care? It’s extremely unlikely. If your medication expenses (co-pays and deductibles) are currently covered under a nationally recognized and commercially available insurance program, then it’s very likely we can bill the same insurance programs as your pharmacy does today. Therefore, your medication co-pays and deductibles with OnePoint Patient Care will be identical to the co-pays and deductibles you are paying today. If a particular medication is NOT covered by your insurance provider, and you are required to pay the full retail price for your medications, then the OnePoint Patient Care medication costs will be priced competitively with the pharmacy you currently use today. 8) Do I have to pay for the delivery service? Delivery fees DO NOT apply for orders that are placed, filled and delivered with hospice- covered medications. Our delivery service is offered free of charge to our hospice NHM.FAQ.AZ.051209 OPPC0000048Opposition No. 91228995 Kirkland Affidavit Exh. 8 3 patients that are also receiving hospice-covered medications with their non-hospice medications delivery. A delivery convenience fee of $10.00 WILL apply for orders that are placed, filled and delivered WITHOUT any hospice-covered medications. 9) How are medications ordered from OnePoint Patient Care? Your medications are ordered by your hospice nurse. The hospice nurse will contact OnePoint Patient Care to place your medication order for you, on your behalf. You simply need to communicate your medication needs to your hospice nurse directly and ensure they have a copy of your most updated pharmacy prescription(s). 10) Who do I call if I have any questions about my prescription/order? If you have any questions about your medications, please contact your hospice nurse directly. They will be happy to answer any questions or comments you have about your order and expected delivery. 11) How often can I have my medications delivered? Your medications will be delivered in daily cycles directly to your home. We require that a designated adult or primary caregiver sign for the medications on your behalf to ensure safe acceptance of your order at your home. As your medications begin to run low, please notify your hospice nurse in advance to ensure that refills are available and delivered in a timely manner. 12) What if my insurance coverage or my credit card information changes for my non-hospice medications? Simply inform your hospice nurse of any insurance or credit card information changes. Your hospice nurse will communicate such changes directly to our pharmacy. 13) Does OnePoint Patient Care accept my current insurance plan? OnePoint Patient Care accepts most common nationally recognized prescription insurance programs. As a matter of fact, we accept so many insurance programs that it’s difficult to list each one individually. It’s easier to tell you the insurance programs we unfortunately can not accept today. They are: A) Veterans Administration Health Benefits recipients B) MediSun 14) How do I manage changes to my medication regimen? We understand that it’s possible for changes to occur in your medication regimen (i.e. changes in your prescription medication type, dosage amounts, dosage intervals, etc.) If such changes occur, simply inform your hospice nurse of any medication regimen changes. Your hospice nurse will communicate such changes directly to our pharmacy. 15) Do you provide “over the counter” or OTC medications? NHM.FAQ.AZ.051209 OPPC0000049Opposition No. 91228995 Kirkland Affidavit Exh. 8 4 Yes we do. You can order the same over the counter (OTC) medications you currently purchase today at your local neighborhood pharmacy. We may not always carry the brand name of medication that you use. If this is the case, please notify your hospice nurse and they will gladly work with our pharmacy to attempt to accommodate your request. 16) Are your prices competitive with my local neighborhood pharmacy? Yes. Our medication prices are competitively priced with other pharmacies. In some cases, there are large retail chains (Walmart, Meijer, Frys) that offer very aggressive pricing on some medications because they purchase in bulk and are able to maximize their purchasing power. We’re not always going to be able to match everyone’s price – but we will always be competitively priced. If you ever have a question about the price of our medications, please notify your hospice nurse and they will be happy to work with our pharmacy to compare our prices with you. 17) Can I pay cash for my medications? No, we only accept credit cards for non-hospice covered medications. 18) How do I use a credit card to make payments to OnePoint Patient Care? It’s very easy to set-up a credit card account with OnePoint Patient Care. All you need to do is: A) Complete a copy of the Credit Card Authorization Form. You can get one from your hospice nurse. B) Provide the completed form to your hospice nurse or fax it directly to OnePoint Patient Care at 480-240-1112, and C) We will set-up your account and begin delivering your medications to you! 19) Will I receive a medication bill/invoice monthly? What will it look like? Patients will receive a monthly statement in the mail that will indicate the medications ordered and the charges that have been made to the credit card for such medications. 20) How do I get started using OnePoint Patient Care for my “non-hospice covered” pharmacy needs? It’s as easy as 1-2-3: 1) See your hospice nurse or a hospice representative for more information about using OnePoint Patient Care. 2) Complete a copy of the Credit Card Authorization Form. 3) Provide the completed form to your hospice nurse and they will fax it directly to OnePoint Patient Care at 480-240-1112. 21) Who do I call if I have questions about OnePoint Patient Care? Simply contact your hospice nurse if you have questions about OnePoint Patient Care. Your hospice nurse will communicate such questions directly to our pharmacy and will endeavor to get answers for you quickly. 22) Is my patient information and privacy protected with OnePoint Patient Care? NHM.FAQ.AZ.051209 OPPC0000050Opposition No. 91228995 Kirkland Affidavit Exh. 8 OnePoint Patient Care Medication Credit Card Authorization Form OnePoint Patient Care will accept credit cards as payment for your medications. We accept Visa, MasterCard, Discover Card and American Express. We will charge the amount due on or after the 1st day of every month and mail you a receipt with your statement. We will charge your credit card for any remaining balance once you leave the facility that we service. This might result in your credit card being charged twice in one month. Patient Name: _________________________________________________ Customer Number: _____________________________________________ Credit Card Holder Name: _______________________________________ Credit Card Billing Address: _____________________________________ _____________________________________ Credit Card Number: ________-________-________-________ Exp Date: ______________ I authorize OnePoint Patient Care to charge my credit card upon dispensing of each order. I understand that this is an optional service provided and that either party may cancel the credit card authorization Agreement at any time. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) _______________________________ (Print Name) 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 Email: Accounting-AR@oppc.com OPPC0000031 Opposition No. 91228995 Kirkland Affidavit Exh. 8 PATIENT NAME: _____________________________________ AUTHORIZATION TO PAY BENEFITS TO PROVIDER: I hereby authorize OnePoint Patient Care to request on my behalf all public and private insurance benefits for products and services supplied to me by OnePoint Patient Care. I further authorize payment for such supplies and/or services to be made directly to: OnePoint Patient Care, 3006 S. Priest Dr. Tempe, AZ 85282. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) PATIENT RELEASE FORM: I hereby authorize any holder of medical and/or insurance information about me to disclose such information to OnePoint Patient Care. I further authorize OnePoint Patient Care to disclose any medical and/or insurance information concerning me in its possession to other professional personnel involved with my care, and to any insurer or other third-party payer who may be responsible for payment of OnePoint Patient Care services. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) FINANCIAL RESPONSIBILITY: So that OnePoint Patient Care may provide me with pharmaceutical products and services prescribed by my physician, I agree that I am responsible to OnePoint Patient Care for payment of all such products and services (one time set up patient authorized). In addition, I agree that I will inform OnePoint Patient Care promptly of any change(s) in my status. This includes, but is not limited to, change in my address, being admitted to a hospital or other nursing facility, or any change that affects third party payment or my ability to pay for products and services rendered by OnePoint Patient Care. OnePoint Patient Care charges a service charge for outstanding balance at .015% of previous balance due. Responsible party agrees to pay all charges. _______________________________ _____________________ (Financial Representative Signature) (Date) _______________________________ _____________________ (Patient Signature) (Date) _______________________________ _____________________ (Care Home) (Date) TCPA EXPRESS CONSENT NOTICE: You agree, in order for us to service our account or to collect any amounts you may owe, we may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or e-mails, using any e-mail address you provide to us. Methods of contact may include using pre-recorded/artificial voice messages and/or use of an automatic dialing device, as applicable. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 Email: Accounting-AR@oppc.com OPPC0000032 Opposition No. 91228995 Kirkland Affidavit Exh. 8 NEW PATIENT INFORMATION FORM Resident Information Name: ___________________________________________ DOB: ____________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: _____________________________ Allergies: ____________________ Social Security #: _________________________________ Doctor Information Doctor Name: __________________________________________________________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: ______________________________ Fax: _______________________ Billing Information (address to send statements) Bill to: _____________________________________ Phone: _______________ Address: _____________________________________________________________ City: ____________________________ State: _____ Zip Code: ____________ Prescription Insurance Information (please include copy of card, front and back) Insurance Name: ______________________________________________________ Phone: ____________________ Address: _____________________________ ID#: _______________________ Group #: _____________________________ Please sign if no prescription coverage: __________________________________ *** OnePoint Patient Care will invoice your account monthly *** 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 OPPC0000033 Opposition No. 91228995 Kirkland Affidavit Exh. 8 NEW PATIENT INFORMATION FORM Resident Information Name: ___________________________________________ DOB: ____________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: _____________________________ Allergies: ____________________ Social Security #: _________________________________ Doctor Information Doctor Name: __________________________________________________________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: ______________________________ Fax: _______________________ Billing Information (address to send statements) Bill to: _____________________________________ Phone: _______________ Address: _____________________________________________________________ City: ____________________________ State: _____ Zip Code: ____________ Prescription Insurance Information (please include copy of card, front and back) Insurance Name: ______________________________________________________ Phone: ____________________ Address: _____________________________ ID#: _______________________ Group #: _____________________________ Please sign if no prescription coverage: __________________________________ *** OnePoint Patient Care will invoice your account monthly *** 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 OPPC0000034 Opposition No. 91228995 Kirkland Affidavit Exh. 8 NEW PATIENT INFORMATION FORM Resident Information Name: ___________________________________________ DOB: ____________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: _____________________________ Allergies: ____________________ Social Security #: _________________________________ Doctor Information Doctor Name: __________________________________________________________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: ______________________________ Fax: _______________________ Billing Information (address to send statements) Bill to: _____________________________________ Phone: _______________ Address: _____________________________________________________________ City: ____________________________ State: _____ Zip Code: ____________ Prescription Insurance Information (please include copy of card, front and back) Insurance Name: ______________________________________________________ Phone: ____________________ Address: _____________________________ ID#: _______________________ Group #: _____________________________ Please sign if no prescription coverage: __________________________________ *** OnePoint Patient Care will invoice your account monthly *** 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 OPPC0000035 Opposition No. 91228995 Kirkland Affidavit Exh. 8 PATIENT NAME: _____________________________________ AUTHORIZATION TO PAY BENEFITS TO PROVIDER: I hereby authorize OnePoint Patient Care to request on my behalf all public and private insurance benefits for products and services supplied to me by OnePoint Patient Care. I further authorize payment for such supplies and/or services to be made directly to: OnePoint Patient Care, 3006 S. Priest Dr. Tempe, AZ 85282. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) PATIENT RELEASE FORM: I hereby authorize any holder of medical and/or insurance information about me to disclose such information to OnePoint Patient Care. I further authorize OnePoint Patient Care to disclose any medical and/or insurance information concerning me in its possession to other professional personnel involved with my care, and to any insurer or other third-party payer who may be responsible for payment of OnePoint Patient Care services. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) FINANCIAL RESPONSIBILITY: So that OnePoint Patient Care may provide me with pharmaceutical products and services prescribed by my physician, I agree that I am responsible to OnePoint Patient Care for payment of all such products and services (one time set up patient authorized). In addition, I agree that I will inform OnePoint Patient Care promptly of any change(s) in my status. This includes, but is not limited to, change in my address, being admitted to a hospital or other nursing facility, or any change that affects third party payment or my ability to pay for products and services rendered by OnePoint Patient Care. OnePoint Patient Care charges a service charge for outstanding balance at .015% of previous balance due. Responsible party agrees to pay all charges. _______________________________ _____________________ (Financial Representative Signature) (Date) _______________________________ _____________________ (Patient Signature) (Date) _______________________________ _____________________ (Care Home) (Date) TCPA EXPRESS CONSENT NOTICE: You agree, in order for us to service our account or to collect any amounts you may owe, we may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or e-mails, using any e-mail address you provide to us. Methods of contact may include using pre-recorded/artificial voice messages and/or use of an automatic dialing device, as applicable. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 Email: Accounting-AR@oppc.com OPPC0000036 Opposition No. 91228995 Kirkland Affidavit Exh. 8 OnePoint Patient Care Medication Credit Card Authorization Form OnePoint Patient Care will accept credit cards as payment for your medications. We accept Visa, MasterCard, Discover Card and American Express. We will charge the amount due on or after the 1st day of every month and mail you a receipt with your statement. We will charge your credit card for any remaining balance once you leave the facility that we service. This might result in your credit card being charged twice in one month. Patient Name: _________________________________________________ Customer Number: _____________________________________________ Credit Card Holder Name: _______________________________________ Credit Card Billing Address: _____________________________________ _____________________________________ Credit Card Number: ________-________-________-________ Exp Date: ______________ I authorize OnePoint Patient Care to charge my credit card upon dispensing of each order. I understand that this is an optional service provided and that either party may cancel the credit card authorization Agreement at any time. _______________________________ _____________________ (Patient/Authorized Representative Signature) (Date) _______________________________ (Print Name) 3006 S. Priest Dr. Tempe, AZ 85282 Phone: (480) 240-1122 Fax: (480) 240-1123 Email: Accounting-AR@oppc.com OPPC0000037 Opposition No. 91228995 Kirkland Affidavit Exh. 8 AUTHORIZATION FORM PATIENT NAME: _____________________________________ AUTHORIZATION TO PAY BENEFITS TO PROVIDER: I hereby authorize OnePoint Patient Care to request on my behalf all public and private insurance benefits for products and services supplied to me by OnePoint Patient Care. I further authorize payment for such supplies and/or services to be made directly to: OnePoint Patient Care, 3006 S. Priest Dr. Tempe, AZ 85282. ________________________________ ______________________ (Patient/Authorized Representative Signature) (Date) PATIENT RELEASE FORM: I hereby authorize any holder of medical and/or insurance information about me to disclose such information to OnePoint Patient Care. I further authorize OnePoint Patient Care to disclose any medical and/or insurance information concerning me in its possession to other professional personnel involved with my care, and to any insurer or other third-party payer who may be responsible for payment of OnePoint Patient Care services. ________________________________ _______________________ (Patient/Authorized Representative Signature) (Date) FINANCIAL RESPONSIBILITY: So that OnePoint Patient Care may provide me with pharmaceutical products and services prescribed by my physician, I agree that I am responsible to OnePoint Patient Care for payment of all such products and services (one time set up patient authorized). In addition, I agree that I will inform OnePoint Patient Care promptly of any change(s) in my status. This includes, but is not limited to, change in my address, being admitted to a hospital or other nursing facility, or any change that affects third party payment or my ability to pay for products and services rendered by OnePoint Patient Care. OnePoint Patient Care charges a service charge for outstanding balance at 15% of previous balance due. Responsible party agrees to pay all charges. __________________________________ _________________________ (Financial Representative Signature) (Date) __________________________________ _________________________ (Patient Signature) (Date) __________________________________ _________________________ (Assisted Living Community) (Date) 3006 S. Priest Drive Phone: (480) 240-1122 Tempe, AZ 85282 Fax: (480) 240-1123 ALAF.AZ.02.08 OPPC0000038 Opposition No. 91228995 Kirkland Affidavit Exh. 8 CREDIT CARD AUTHORIZATION FORM OnePoint Patient Care accepts credit cards as a form of payment for your medications. For your convenience, we accept Visa, MasterCard, Discover Card and American Express. We will charge the amount due on or after the 1st day of every month and mail you a receipt with your statement. Patient Name: ____________________________________ Pharmacy Account #: ______________________________ Card Holder Name: ________________________________ Credit Card Number: ________-________-________-________ Exp Date: ______________ I authorize OnePoint Patient Care to charge my credit card on or after the first day of every month for the total due on my account. I understand that this is an optional service provided and that either party may cancel the credit card authorization Agreement at any time. Signature of cardholder or authorized user: __________________________________ Date: __________________ 3006 S. Priest Drive Phone: (480) 240-1122 Tempe, AZ 85282 Fax: (480) 240-1123 ALCCAF.AZ.0608 OPPC0000040 Opposition No. 91228995 Kirkland Affidavit Exh. 8 CREDIT CARD AUTHORIZATION FORM OnePoint Patient Care accepts credit cards as a form of payment for your medications. For your convenience, we accept Visa, MasterCard, Discover Card and American Express. We will charge the amount due on or after the 1st day of every month and mail you a receipt with your statement. Patient Name: ____________________________________ Pharmacy Account #: ______________________________ Card Holder Name: ________________________________ Credit Card Number: ________-________-________-________ Exp Date: ______________ I authorize OnePoint Patient Care to charge my credit card on or after the first day of every month for the total due on my account. I understand that this is an optional service provided and that either party may cancel the credit card authorization Agreement at any time. Signature of cardholder or authorized user: __________________________________ Date: __________________ 3006 S. Priest Drive Phone: (480) 240-1122 Tempe, AZ 85282 Fax: (480) 240-1123 ALCCAF.AZ.0608 OPPC0000041 Opposition No. 91228995 Kirkland Affidavit Exh. 8 NEW PATIENT INFORMATION FORM Resident Information Name: ___________________________________________ DOB: ___________ Address: _______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: _____________________________ Allergies: ____________________ Doctor Information Doctor Name: __________________________________________________________ Address: ______________________________________________________________ City: ___________________________ State: ______ Zip Code: ___________ Phone: ______________________________ Fax: _______________________ Billing Information (address to send statements) Bill to: _____________________________________ Phone: _______________ Address: _____________________________________________________________ City: ____________________________ State: _____ Zip Code: ____________ Prescription Insurance Information (please include copy of card, front and back) Insurance Name: ______________________________________________________ Phone: ____________________ Address: _____________________________ ID#: _______________________ Group #: _____________________________ Please sign if no prescription coverage: __________________________________ *** Credit card information is REQUIRED for all hospice patients (on and off service) *** *** OnePoint Patient Care will bill your credit card monthly *** 3006 S. Priest Drive Phone: (480) 240-1122 Tempe, AZ 85282 Fax: (480) 240-1123 ALNPIF.AZ.0208 OPPC0000043 Opposition No. 91228995 Kirkland Affidavit Exh. 8 OnePoint Patient Care Uncovered/Non-Hospice Medication Authorization Form Patient Name: _______________________________ Date of Birth: ____________ Authorization of Financial Responsibility: So that OnePoint Patient Care may provide me with pharmaceutical products (and delivery of such products) and services prescribed by my physician, I agree that I am responsible to OnePoint Patient Care for payments of all such products, delivery charges and services. In addition, I agree that I will inform OnePoint Patient Care promptly of any change(s) in my status. This includes, but is not limited to, change in my address, being admitted to a hospital or other nursing facility, or any change that affects third party payment or my ability to pay for products (including delivery charges) and services rendered by OnePoint Patient Care. I represent to OnePoint Patient Care that I have authorized the hospice to order products and services from OnePoint Patient Care. Authorization to Pay Benefits: I hereby authorize OnePoint Patient Care to request on my behalf all public and private insurance benefits for products, delivery charges and services supplied to me by OnePoint Patient Care. I further authorize payment for such supplies and/or services to be made directly to: OnePoint Patient Care, 3006 S. Priest Dr. Tempe, AZ 85282. Authorization to Release Information: I hereby authorize any holder of medical and/or insurance information about me to disclose such information to OnePoint Patient Care. I further authorize OnePoint Patient Care to disclose any medical and/or insurance information concerning me in its possession to other professional personnel involved with my care, and to any insurer or other third-party payer who may be responsible for payment of OnePoint Patient Care services. Insurance Information **A copy of the front and back of your insurance card(s) MUST be attached** Insurance Name: _____________________________________________________________ Address: ___________________________________________________________________ Phone: _______________________ ID#: ___________________________ Group#: _______________________ BIN#: ___________________________ Please initial if no insurance coverage: _______ Financial Responsible Party Bill to: ___________________________________ Phone: ___________________________ Address: _______________________ City: __________________ State: _____ ZIP:_________ By signing below, Patient/Responsible Party acknowledges that he/she has received, read, understands and agrees to the terms of the "Explanation of Pharmacy Services" letter. __________________________________________ __________________________ Patient/Authorized Representative Signature Date 3006 S. Priest Drive Phone: (480) 240-1111 Tempe, AZ 85282 Fax: (480) 240-1112 NHM.AUTH.AZ.050509 OPPC0000045Opposition No. 91228995 Kirkland Affidavit Exh. 8 OnePoint Patient Care Uncovered/Non-Hospice Medication Credit Card Authorization Form OnePoint Patient Care will accept credit cards as payment for medications not financially covered by your hospice. We accept Visa, MasterCard, Discover Card and American Express. We will charge the amount due upon dispensing of each order. Patient Name: _____________________________________ Patient Date of Birth: _____________________________________ Credit Card Holder Name: ____________________________ Credit Card Billing Address: ____________________________ City: ____________________________ State: ____________________________ Zip: ____________________________ Phone: ____________________________ Credit Card Number: ________-________-________-________ Exp Date: ______________ I authorize OnePoint Patient Care to charge my credit card upon dispensing of each order. I understand that this is an optional service provided and that either party may cancel the credit card authorization Agreement at any time. Signature of cardholder or authorized user: __________________________________ Date: __________________ 3006 S. Priest Drive Phone: (480) 240-1111 Tempe, AZ 85282 Fax: (480) 240-1112 NHM.CCAUTH.AZ.031109 OPPC0000046Opposition No. 91228995 Kirkland Affidavit Exh. 8 1 OnePoint Patient Care Uncovered Pharmacy Drugs & Services (Medications not financially covered by Hospice) Frequently Asked Questions (FAQs) 1) What is OnePoint Patient Care? OnePoint Patient Care is the nation’s leading locally-based hospice pharmacy that dispenses and delivers hospice medications in each market we serve. We deliver hospice covered medications direct to your door, and as an added convenience to our patients, we offer the ability for you to order and receive non-hospice covered medications as well. Our clinical professionals are dedicated to and focused on the unique needs of hospice patients by providing a thorough clinical review and complete medication profiling for a patient’s entire drug regimen. OnePoint’s attentive Customer Care Specialists (delivery personnel) help ensure timely and accurate delivery of all medications. Our goal is to provide our patients, their caregivers and family members with the highest quality of care, reliability, and support while dispensing and delivering medications, and providing clinical advice. 2) What does the term “hospice covered medications” mean? The Medicare hospice benefit covers medications needed to treat symptoms that occur as a result of a hospice patient’s terminal illness and related conditions. Generally, your hospice provider will order medications for you, and we will deliver them direct to your home. All new orders are delivered same day. All refill orders are delivered next day. Medications for a condition not related to your terminal illness – a cholesterol lowering medication for example – is typically not “financially” covered by your hospice because it is not covered by the Medicare hospice benefit. 3) What does the term “non-hospice covered” or “non-related” medications mean? Medications not directly related to the management of symptoms that occur as a result of hospice patients’ terminal diagnosis and other related conditions are considered non- hospice covered medications under the Medicare hospice benefit, and therefore are not financially covered by your hospice provider. Although these medications may not be paid for by your hospice provider, they may be a medication that you or your loved one wishes to continue taking. If this is the case, we offer you the convenience of ordering your non-covered medications through our hospice pharmacy, we will deliver them directly to your doorstep, and we will gladly bill your existing private insurance plan and charge the remaining balance or your co-pay to a credit card. If the hospice patient does not have a credit card, we will also accept credit cards for a primary care giver or family member. NHM.FAQ.AZ.051209 OPPC0000047Opposition No. 91228995 Kirkland Affidavit Exh. 8 2 4) Why should I use OnePoint Patient Care to provide my non-hospice covered medications? OnePoint Patient Care is a complete pharmacy service provider. We dispense and deliver both covered and non-covered medications for our hospice patients. If you did not choose to order your non-hospice covered medications through OnePoint Patient Care, it’s likely you or a loved one would have to call the order into your local neighborhood retail pharmacy, wait for the medications to be dispensed and then go to the pharmacy to pick-up the medications yourself. By using OnePoint, the medications are ordered by your hospice nurse and delivered to your doorstep with your hospice medications. 5) Is “convenience” the only advantage to using OnePoint for my non-hospice covered medications? NO! A more important benefit of having OnePoint Patient Care dispense your hospice covered and non-hospice covered medications is the complete medication screening we offer for your entire medication regimen. It can be potentially unsafe for you to use multiple pharmacies to provide your medications because each pharmacy may not have access to information regarding your entire medication profile. By having OnePoint as your complete pharmacy service provider, we profile your entire medication regime, screen for drug-to-drug interactions, screen for duplicate therapies and medication allergies to ensure the absolute highest quality of clinical and therapeutic outcomes for you. 6) I’m completely satisfied with my neighborhood pharmacy. You may be “satisfied” with your current pharmacy – but we promise, you will be “thrilled” by the level of support, service and expertise you receive from OnePoint Patient Care as your pharmacy. - Does your existing neighborhood pharmacy deliver your medications direct to your home? We do! - Does your current pharmacy screen 100% of your prescriptions and medications before your order is dispensed and filled? We do! - Does your current pharmacy discuss any medication related issues they find with your nurse or physician before your order is dispensed and filled? We do! 7) Is there a price difference with OnePoint Patient Care? It’s extremely unlikely. If your medication expenses (co-pays and deductibles) are currently covered under a nationally recognized and commercially available insurance program, then it’s very likely we can bill the same insurance programs as your pharmacy does today. Therefore, your medication co-pays and deductibles with OnePoint Patient Care will be identical to the co-pays and deductibles you are paying today. If a particular medication is NOT covered by your insurance provider, and you are required to pay the full retail price for your medications, then the OnePoint Patient Care medication costs will be priced competitively with the pharmacy you currently use today. 8) Do I have to pay for the delivery service? Delivery fees DO NOT apply for orders that are placed, filled and delivered with hospice- covered medications. Our delivery service is offered free of charge to our hospice NHM.FAQ.AZ.051209 OPPC0000048Opposition No. 91228995 Kirkland Affidavit Exh. 8 3 patients that are also receiving hospice-covered medications with their non-hospice medications delivery. A delivery convenience fee of $10.00 WILL apply for orders that are placed, filled and delivered WITHOUT any hospice-covered medications. 9) How are medications ordered from OnePoint Patient Care? Your medications are ordered by your hospice nurse. The hospice nurse will contact OnePoint Patient Care to place your medication order for you, on your behalf. You simply need to communicate your medication needs to your hospice nurse directly and ensure they have a copy of your most updated pharmacy prescription(s). 10) Who do I call if I have any questions about my prescription/order? If you have any questions about your medications, please contact your hospice nurse directly. They will be happy to answer any questions or comments you have about your order and expected delivery. 11) How often can I have my medications delivered? Your medications will be delivered in daily cycles directly to your home. We require that a designated adult or primary caregiver sign for the medications on your behalf to ensure safe acceptance of your order at your home. As your medications begin to run low, please notify your hospice nurse in advance to ensure that refills are available and delivered in a timely manner. 12) What if my insurance coverage or my credit card information changes for my non-hospice medications? Simply inform your hospice nurse of any insurance or credit card information changes. Your hospice nurse will communicate such changes directly to our pharmacy. 13) Does OnePoint Patient Care accept my current insurance plan? OnePoint Patient Care accepts most common nationally recognized prescription insurance programs. As a matter of fact, we accept so many insurance programs that it’s difficult to list each one individually. It’s easier to tell you the insurance programs we unfortunately can not accept today. They are: A) Veterans Administration Health Benefits recipients B) MediSun 14) How do I manage changes to my medication regimen? We understand that it’s possible for changes to occur in your medication regimen (i.e. changes in your prescription medication type, dosage amounts, dosage intervals, etc.) If such changes occur, simply inform your hospice nurse of any medication regimen changes. Your hospice nurse will communicate such changes directly to our pharmacy. 15) Do you provide “over the counter” or OTC medications? NHM.FAQ.AZ.051209 OPPC0000049Opposition No. 91228995 Kirkland Affidavit Exh. 8 4 Yes we do. You can order the same over the counter (OTC) medications you currently purchase today at your local neighborhood pharmacy. We may not always carry the brand name of medication that you use. If this is the case, please notify your hospice nurse and they will gladly work with our pharmacy to attempt to accommodate your request. 16) Are your prices competitive with my local neighborhood pharmacy? Yes. Our medication prices are competitively priced with other pharmacies. In some cases, there are large retail chains (Walmart, Meijer, Frys) that offer very aggressive pricing on some medications because they purchase in bulk and are able to maximize their purchasing power. We’re not always going to be able to match everyone’s price – but we will always be competitively priced. If you ever have a question about the price of our medications, please notify your hospice nurse and they will be happy to work with our pharmacy to compare our prices with you. 17) Can I pay cash for my medications? No, we only accept credit cards for non-hospice covered medications. 18) How do I use a credit card to make payments to OnePoint Patient Care? It’s very easy to set-up a credit card account with OnePoint Patient Care. All you need to do is: A) Complete a copy of the Credit Card Authorization Form. You can get one from your hospice nurse. B) Provide the completed form to your hospice nurse or fax it directly to OnePoint Patient Care at 480-240-1112, and C) We will set-up your account and begin delivering your medications to you! 19) Will I receive a medication bill/invoice monthly? What will it look like? Patients will receive a monthly statement in the mail that will indicate the medications ordered and the charges that have been made to the credit card for such medications. 20) How do I get started using OnePoint Patient Care for my “non-hospice covered” pharmacy needs? It’s as easy as 1-2-3: 1) See your hospice nurse or a hospice representative for more information about using OnePoint Patient Care. 2) Complete a copy of the Credit Card Authorization Form. 3) Provide the completed form to your hospice nurse and they will fax it directly to OnePoint Patient Care at 480-240-1112. 21) Who do I call if I have questions about OnePoint Patient Care? Simply contact your hospice nurse if you have questions about OnePoint Patient Care. Your hospice nurse will communicate such questions directly to our pharmacy and will endeavor to get answers for you quickly. 22) Is my patient information and privacy protected with OnePoint Patient Care? NHM.FAQ.AZ.051209 OPPC0000050Opposition No. 91228995 Kirkland Affidavit Exh. 8 5 Yes. All of your information is kept strictly confidential and protected by OnePoint Patient Care. We are HIPAA compliant, meaning we adhere to the strict government standards for patient privacy protection. HIPAA stands for The Health Insurance Portability and Accountability Act of 1996. For more information on your privacy rights and HIPAA, please feel free to contact: The U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 Telephone: 202-619-0257 Toll Free: 1-877-696-6775 Website: www.hhs.gov 23) How can I learn more about OnePoint Patient Care? Visit us online at www.oppc.com. NHM.FAQ.AZ.051209 OPPC0000051Opposition No. 91228995 Kirkland Affidavit Exh. 8 OnePoint Patient Care Uncovered/Non-Hospice Medication Protocol For Hospice Patients Dear Valued Hospice Partner: As part of our new clinical services program, OnePoint Patient Care is pleased to offer you and your hospice patients the opportunity to get their uncovered/non-hospice medications from OnePoint Patient Care. Specifically, these are medications that the hospice has determined the patient needs but that will not be financially covered by your hospice. Enclosed are pre-packaged folders containing all necessary paperwork you may present to a patient or their family members upon admission, including: • Introductory Letter telling patient/family what they need to do to get started • Frequently Asked Questions • Medication Authorization & Patient Insurance Form • Credit Card Authorization Form • Sample Billing Statement It is important that hospice personnel understand the conditions of participation in this program. 1. Only hospice nurses may call in or fax new orders or refills for uncovered/non-hospice medications (refill requests by patients or their family will not be allowed) 2. Uncovered/non-hospice medications will be delivered at the same time the covered hospice medications are delivered; except a) If a separate delivery is required to deliver the uncovered/non-hospice medications because there were no hospice medications to be delivered or there was an insurance processing delay due to prior authorization by the patient’s insurance company, during normal business hours, there will be a $10 convenience fee charged to the patient. b) For orders placed and filled outside the Pharmacy normal business hours, the Pharmacy will charge an after hours/on call fee of $65. 3. The Pharmacy’s normal business hours are: Monday - Friday 8am – 8pm, Saturday, Sunday and Holidays, 8am – 6pm. 4. OnePoint Patient Care will only fill uncovered/non-hospice medications for those patients who have filled out all the paperwork and provided us with a valid credit card to be billed. All the patient’s co-pay amounts for uncovered/non-hospice medications, along with any convenience fee, will be billed to the designated credit card PRIOR to leaving the pharmacy. 5. Any uncovered/non-hospice medications ordered that are NOT covered by the patient’s third party insurance will NOT be processed at OnePoint Patient Care without prior authorization. We will contact the patient’s physician for a prior authorization. If we are unable to get the prior authorization, we will contact you for the patient’s approval to bill their credit card directly. 6. If the credit card cannot be billed, the uncovered/non-hospice medications will not be sent. 7. Each month, a detailed statement will be sent to the patient or their designee detailing the medications provided the cost of the medications and the amount charged to their credit card. OnePoint Patient Care offers this service as a benefit to our hospice partners and its patients. NHM.OLTH.052209 OPPC0000052 Opposition No. 91228995 Kirkland Affidavit Exh. 8 OnePoint Patient Care Explanation of Pharmacy Services Dear Patient, Family Member or Primary Caregiver: OnePoint Patient Care is your hospice provider’s preferred pharmacy. We work closely with the hospice agency to provide for all the medications covered by the hospice under the hospice benefit. As a service to our hospice partners and their patients, OnePoint Patient Care is pleased to offer hospice patients the opportunity to receive their uncovered/non-hospice medications from OnePoint Patient Care. Specifically, these are medications that the hospice has determined the patient needs but that will not be financially covered by your hospice. Enclosed is all necessary paperwork you need to read and complete should you wish to have OnePoint Patient Care dispense and deliver your medications that are not financially covered by the hospice. The forms include: • Frequently Asked Questions • Medication Authorization & Patient Insurance Form • Credit Card Authorization Form • Sample Billing Statement It is important that you or the financially responsible party understand the conditions of participation in this program. 1. Only hospice nurses or personnel may call in or fax new orders or refills to OnePoint Patient Care for uncovered/non-hospice medications (refill requests by patients or their family will not be allowed). 2. Uncovered/non-hospice medications will be delivered at the same time the covered hospice medications are delivered; except a) If a separate delivery is required to deliver the uncovered/non-hospice medications because there were no hospice medications to be delivered or there was an insurance processing delay due to prior authorization by the patient’s insurance company, during normal business hours, there will be a $10 convenience fee charged to the patient. b) For orders placed and filled outside the Pharmacy normal business hours, the Pharmacy will charge an after hours/on call fee of $65. 3. The Pharmacy’s normal business hours are: Monday - Friday 8am – 8pm, Saturday, Sunday and Holidays, 8am – 6pm. 4. OnePoint Patient Care will only fill uncovered/non-hospice medications for those patients who have filled out all the paperwork and provided us with a valid credit card to be billed. All of your co-pay amounts for uncovered/non-hospice medications, along with any convenience fee, will be billed to the designated credit card PRIOR to leaving the pharmacy. 5. Any uncovered/non-hospice medications ordered that are NOT covered by your third party insurance will NOT be processed at OnePoint Patient Care without prior authorization. We will contact your physician for a prior authorization. If we are unable to get the prior authorization, we will contact your hospice nurse with cost information and request your approval to bill you directly for that medication. 6. If the credit card cannot be billed, the uncovered/non-hospice medications will not be sent. 7. Each month, a detailed statement will be sent detailing the medications provided by OnePoint Patient Care, the cost of the medications and the amount charged to your designated credit card. To get started, the patient or financially responsible party should sign the enclosed documents and return to your hospice representative. Thank you for choosing OnePoint Patient Care for your pharmacy needs. NHM.OLTP.052209 OPPC0000053 Opposition No. 91228995 Kirkland Affidavit Exh. 8 1 NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Effective Date of Notice: April 14, 2003 Uses and Disclosures of Protected Health Information 1. Under applicable law, we are required to protect the privacy of your individual health information (information we refer to in this notice as “Protected Health Information”). We are also required to provide you with this Notice regarding our policies and procedures regarding your Protected Health Information (we will refer to this as “PHI’ for the rest of the document) and to abide by the terms of this notice, as it may be updated from time to time. We are permitted to make certain types of uses and disclosures under applicable law for treatment, payment, and healthcare operations purposes. We may obtain information to dispense prescriptions and for the documentation of pertinent information in your records that may assist us in managing your medication therapy or your overall health. For treatment purposes, such use and disclosure will take place in providing, coordination, or managing healthcare and its related services by one or more of your providers, such as when your pharmacist consults with your physician or a specialist regarding your medications, treatment, or condition. For payment purposes, such use and disclosure will take place to obtain or provide reimbursement for providing pharmaceutical care services, such as when your case is reviewed to ensure that appropriate care was rendered. For reimbursement purposes, your PHI may be disclosed to one or several intermediaries employed by your plan sponsor including “but not limited to insurers, pharmacy benefits managers, claims administrators and computer switching companies. For healthcare operations purposes, such use and disclosure will take place in a number of ways, including for quality assessment and improvement; provider review and training; underwriting activities; reviews and compliance activities; and planning, development, management, and administration. Your information could be used, for example, to assist in the evaluation of the quality of care that you were provided. We store some of your PHI in electronic computer files and employ precautions to safeguard the integrity of your PHI. In spite of these precautions it is possible but unlikely that a computer crash or other technological failure could cause the loss of data. In addition, reasonable safeguards are employed to protect your PHI stored on electronic media. We may use and disclose your PHI, without your authorization when the pharmacy needs to contact a physician or physician’s staff and is permitted or required to do so without individual written authorization. We may use and disclose your PHI if we are contacted by another pharmacy who states they have your request and consent to transfer pharmacy records to them. From time to time we may employ the services of business associates who may assist us in one or more tasks and who may use, change, or create PHI. Business associates are required to comply with all the privacy regulations on your behalf. 3006 S. Priest Drive Phone: (480) 240-1122 Tempe, AZ 85282 Fax: (480) 240-1123 ALNOPP..AZ.0208 OPPC0000054Opposition No. 91228995 Kirkland Affidavit Exh. 8 2 We may disclose PHI about you without your authorization to comply with workers compensation laws, as required by law enforcement, legal proceedings, public health requirements, health oversight activities and as required by law. Other uses and disclosures will be made only with your written authorization, and you may revoke your authorization by notifying us in writing. 2. You may ask us to restrict uses and disclosures of your PHI to carry out treatment, payment, or healthcare operations, or to restrict uses and disclosures to family members, relatives, friends, or other persons identified by you who are involved in your care or payment for your care. However, we are not required to agree to your request. 3. You have the right to request the following with respect to your PHI; (i) inspection and copying; (ii) amendment or correction; (iii) an accounting of the disclosures of this information by us (we are not required to account to your for disclosures made for treatment, payment, operations, disclosures to you, disclosures to your care givers, for notifications or as otherwise excluded by law); and (iv) the right to receive a paper copy of this notice upon request. We may require you to pay for this request to cover our costs of copying, labor, and postage. In addition, you may request, and we must accommodate the request, if reasonable, to receive communications of PHI by alternative means or at alternative locations. To make this request, or for further information please contact, in writing: OnePoint Patient Care Privacy Officer 3006 S. Priest Drive Tempe, AZ 85282 4. We may use your name to reference your prescriptions and pharmaceutical care services. You may be required to sign a signature log form to acknowledge receipt of service, to acknowledge receipt of this Notice and the disclosure of PHI as outlined herein. This information may be disclosed by us to other persons who ask for you or your prescriptions by name. You may restrict or prohibit these uses and disclosures by notifying a pharmacy representative in writing of your restriction or prohibition. We are not required to honor those requests. We are able to provide treatment services to you even if you object to sign the acknowledgment of the receipt of this Notice or if we decide not to honor a request regarding the information in this document. In the event of an emergency or your incapacity, we will do in our reasonable judgment what is consistent with your known preference, and what we determine to be in your best interest. We will inform you of any such uses or disclosures if uses and disclosures would require your signed authorization under such circumstances and give you an opportunity to object as soon as practicable. 5. We may disclose to your personal representative PHI that is directly relevant to the person’s involvement with your care or payment related to your care. If you are incapacitated, there is an emergency, or you object to this use or disclosure, we will do in our judgment what is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person’s involvement with your healthcare. We will also use our judgment and experience regarding your best interest in allowing people to pick-up prescriptions, or other similar forms of PHI. 6. We reserve the right to change the terms of this Notice and to make new Notice provisions effective for all PHI we maintain. You may receive a copy of this Notice by contacting us or upon the receipt of pharmacy care services. 7. If you believe that your privacy rights have been violated, you may complain to us at the location described in Section 3 or to the Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201. You will not be retaliated against for filing a complaint. Please sign below to indicate that you have read, understand and acknowledge the notice of privacy practices. Signature: ___________________________________________________ Date: ___________ ALNOPP..AZ.0208 OPPC0000055Opposition No. 91228995 Kirkland Affidavit Exh. 8 ONEPOINT PATIENT CARE’S NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. OnePoint is required by law to provide you with this Notice so that you will understand how we may use or share your information from your Designated Record Set. The Designated Record Set includes financial and health information referred to in this Notice as Protected Health Information (“PHI”) or simply “health information.” We are required to adhere to the terms outlined in this Notice. If you have any questions about this Notice, please contact OnePoint’s Privacy Officer. UNDERSTANDING YOUR HEALTH RECORD AND INFORMATION. Each time OnePoint dispenses medication(s) to you, a record of the medication(s) dispensed is made containing health information. OnePoint’s record of you may also contain financial information. Typically, this record contains information about your condition, the medication(s) we provide and payment for the treatment. We may use and/or disclose this information to: (1) plan for your medication; (2) communicate with other health professionals involved in your care; (3) document the medications you receive; (3) educate heath professionals; (4) provide information for medical research; (5) provide information to public health officials; (6) evaluate the medications we provide; (7) obtain payment for the care we provide; and, (8) understanding what is in your record and how your health information is used helps you to: (a) ensure it is accurate; (b) better understand who may access your health information; and, (c) make more informed decisions when authorizing disclosure to others. HOW WE MAY USE AND DISCLOSE PHI ABOUT YOU The following categories describe the ways that we use and disclose your PHI. Not every use or disclosure in a category will be listed. Treatment. We may use or disclose health information about you to provide you with medical treatment. We may disclose health information about you to doctors, nurses, therapists or other personnel who are involved in your care. For example, we may disclose PHI to pharmacists, doctors, nurses, technicians and other personnel involved in your health care. We may also disclose your PHI with other third parties, such as hospice personnel, hospitals, other pharmacies and other health care facilities and agencies to facilitate the provision of health care services, medications, equipment and supplies you may need. This helps to coordinate your care and make sure that everyone who is involved in your care has the information that they need about you to meet your health care needs. We may also disclose health information about you to people who may be involved in your medical care and this may include family members or nurses visiting your home or at a facility to provide for your care. Payment. We may use and disclose your PHI in order to obtain payment for the medication products and services that we provide to you and for other payment activities related to the services that we provide. For example, we may contact your hospice, assisted living facility, insurer, pharmacy benefit manager or other health care payor to determine whether it will pay for the medication products and services you need and to determine the amount of your co-payment. We will bill your hospice, you or a third-party payor for the cost of medication products and services we provide to you. The information on or accompanying the bill may include information that identifies you, as well as information about the services that were provided to you or the medications you are taking. We may also disclose your PHI to other health care providers or HIPAA covered entities who may need it for their payment activities. Health Care Operations. We may use and disclose health information about you for our day-to-day health care operations. Health care operations are activities necessary for us to operate our business. For example, we may use your PHI to monitor the performance of our pharmacists, pharmacy technicians and other staff that provide medication(s) to you. We may use your PHI as part of our efforts to continually improve the quality and effectiveness of the medications and services we provide. We may also analyze PHI to improve the quality and efficiency of health care, for example, to assess and improve outcomes. We may also disclose your PHI to other HIPAA covered entities that have provided services to you so that they can improve the quality and effectiveness of the health care services that they provide. PHI about you may be used by our corporate office for business development and planning, cost management analyses, insurance claims management, risk management activities, and in developing and testing information systems and programs. We may also use and disclose information for professional review, performance evaluation, and for training programs. Other aspects of health care operations that may require use and disclosure of your health information include accreditation, certification, licensing and credentialing activities, review and auditing, including compliance reviews, pharmacy reviews, legal services and compliance programs. Your health information may be used and disclosed for the business management and general activities of OnePoint including resolution of internal grievances, customer service and due diligence in connection with a sale or transfer of OnePoint. In limited circumstances, we may disclose your Page 1 of 3 OPPC0000056 Opposition No. 91228995 Kirkland Affidavit Exh. 8 health information to another entity subject to HIPAA for its own health care operations. We may remove information that identifies you so that the health information may be used to study health care and health care delivery without learning the identities of patients. OTHER ALLOWABLE USES OF YOUR HEALTH INFORMATION WITHOUT YOUR PRIOR AUTHORIZATION Business Associates. There are some services provided to you through contracts with business associates. Examples include hospice nurses, hospice medical directors, doctors and outside attorneys and a copy service we may use when making copies of your health record. When these services are contracted, we may disclose your health information so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information. Providers. Many services provided to you are offered by participants in one of our organized healthcare arrangements. These participants include a variety of providers such as hospice personnel, nurses, and physicians. Medication Alternatives. We may use and disclose health information to tell you about possible medication options or alternatives that may be of interest to you. Health-Related Benefits and Services and Reminders. We may contact you to provide medication reminders or information about medication alternatives or other health-related benefits and services that may be of interest to you. Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose health information about you to a friend or family member who is involved in your care. We may also give information to someone who helps pay for your care. As Required By Law. We will disclose health information about you when required to do so by federal, state or local law. To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you to prevent a serious threat to your health and safety or the health and safety of the public or another person. We would do this only to help prevent the threat. Military and Veterans. If you are a member of the armed forces, we may disclose health information about you as required by military authorities. Research. Under certain circumstances, we may use and disclose your PHI for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. Your PHI will only be disclosed after the research study has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your information. Workers’ Compensation. We may disclose health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness. Reporting. Federal and state laws may require or permit OnePoint to disclose certain health information related to the following: (1) Public Health Risks. We may disclose PHI about you for public health purposes, including: (a) prevention or control of disease, injury or disability; (b) reporting births and deaths; (c) reporting child abuse or neglect; (d) reporting reactions to medications or problems with products; (e) notifying people of recalls of products; (f) notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease; (g) notifying the appropriate government authority if we believe a resident has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law. (2) Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. (3) Judicial and Administrative Proceedings. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. (4) Reporting Abuse. Neglect or Domestic Violence: Notifying the appropriate government agency if we believe a resident has been the victim of abuse, neglect or domestic violence. Law Enforcement. We may disclose health information when requested by a law enforcement official: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) about you, the victim of a crime if, under certain limited circumstances, we are unable to obtain your agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct in connection with your care or our dispensing of medications; or, (6) in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime. Coroners, Medical Examiners and Funeral Directors. We may disclose medical information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also disclose medical information to funeral directors as necessary to carry out their duties. Page 2 of 3 OPPC0000057 Opposition No. 91228995 Kirkland Affidavit Exh. 8 National Security and Intelligence Activities. We may disclose health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution or its agents health information necessary for your health and the health and safety of others. OTHER USES OF HEALTH INFORMATION Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you. YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU Although your health record is the property of OnePoint, the information belongs to you. You have the following rights regarding your health information: Right to Inspect and Copy. With some exceptions, you have the right to review and copy your health information. We may charge a fee for the costs of copying, mailing or other supplies associated with your request. Right to Amend. If you feel that health information in your record is incorrect or incomplete, you may ask us to amend the information. You have this right for as long as the information is kept by or for OnePoint. In addition, you must provide a reason for your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may deny your request if you ask us to amend information that: (1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (2) is not part of the health information kept by or for OnePoint; or (3) is accurate and complete. Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures”. This is a list of certain disclosures we made of your health information, other than those made for purposes such as treatment, payment, or health care operations. Your request must state a time period which may not be longer than six years from the date the request is submitted. Your request should indicate in what form you want the list (for example, on paper or electronically). Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you. For example, you may request that we limit the health information we disclose to someone who is involved in your care or the payment for your care. We will honor your reasonable request, but we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. Right to Request Alternate Communications. You have the right to request that we communicate with you about medical matters in a confidential manner or at a specific location. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests. Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice of Privacy Practices even if you have agreed to receive the Notice electronically. You may ask us to give you a copy of this Notice at any time. CHANGES TO THIS NOTICE We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice on our website, www.oppc.com. If material changes are made to this Notice, the Notice will contain an effective date for the revisions and copies can be obtained by contacting the any OnePoint pharmacy. COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with OnePoint or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint. NOTICES Any and all notices, requests or questions in connection with this Privacy Notice should be sent to the following address: OnePoint Patient Care, LLC, 8130 Lehigh Ave., Morton Grove IL 60053, Attn: Privacy Officer. Effective Date: This Notice is effective as of February 14, 2014. Page 3 of 3 OPPC0000058 Opposition No. 91228995 Kirkland Affidavit Exh. 8 Custom-designed dispensing and delivery models including OnePoint Local Pharmacy and Mail Order Pharmacy services Transparent, cost-plus Pharmacy Beneits Managemen (PBM) services for national, multi-regional and stand-alone hospices 25 years of clinical expertise Hospice management integration E-prescribing capabilities via our Patient Care App To learn more please call us at 866.771.OPPC (6772) or email sales@oppc.com www.onepointpatientcare.com The only national hospice pharmacy capable of providing local deliveries to your patients daily within hours! We’re dedicated to the unique service needs of hospice with the ability to customize all elements of our service offering. Our exclusive local dispensing and delivery model will provide you with a custom-designed preferred drug list, cost-containment tools, state-of-the-art reporting and local same-day deliveries made within hours. Please visit us in Booth 200 to learn more about how we enable you to improve patient outcomes more efficiently and cost-effectively. OPPC0000001 Opposition No. 91228995 Kirkland Affidavit Exh. 9 A DEDICATED HOSPICE PHARMACY Our superior service model is founded on the simple principle that outstanding patient care can best be achieved when hospice pharmacy specialists screen and dispense medications locally and deliveries are made in a timely manner direct to patient sites by our own captive delivery personnel. As a dedicated hospice pharmacy, we’re willing and capable of customizing a formulary for each hospice program we serve. We believe that every hospice has unique clinical and inancial needs; therefore, hospices should utilize their own unique formulary allowing them to achieve their individual objectives. Our clinical professionals have the experience and knowledge required to assist you in the creation of a distinct formulary designed exclusively for your patients and hospice program. CLINICAL CONSULTING AND DRUG SCREENING Our experienced clinical professionals offer detailed, immediate therapeutic consulting with every call. We offer hospices the unique ability to screen each patient’s drug therapy based on terminal diagnosis, and we screen for duplicate therapies. We offer hospices complete compliance with the latest hospice COPs (Conditions of Participation) related to the initial and comprehensive assessment of the patient as well as the entire patient drug therapy. We offer a robust library of in-service education programs for hospice team members and our clinical experts are happy to participate in hospice IDG (Inter-Disciplinary Group) meetings and offer CQI (Continuous Quality Improvement) team support. OnePoint Patient Care is the nation’s only locally based hospice pharmacy services provider. Our Hospice Pharmacy Centers of Excellence™ allow us to provide daily deliveries from our local dispensing pharmacies in every market we serve. We’re different from any other local or national hospice pharmacy or hospice PBM because we will create a local Hospice Pharmacy Center of Excellence in your city. Our local Hospice Pharmacy Center of Excellence will ill and dispense medications, create custom compounds and provide same-day deliveries for 100% of your patients, regardless of patient setting. We offer exceptional clinical advice dedicated to the needs of hospice and provide formulary compliance and cost- management programs unique to each hospice partner we serve. A Dedicated Hospice Pharmacy Clinical Consulting and Drug Screening Clinical Management Solutions (PBM/PBA) Local Hospice Pharmacy Center of Excellence Delivery Direct to Home Phone: 866.771.OPPC (6772) Web: www.onepointpatientcare.com CLINICAL MANAGEMENT SOLUTIONS (PBM/PBA) We offer medication management programs designed to provide superior, yet cost-effective, end- of-life care. Our clinicians provide comprehensive cost- containment measures and hospice-speciic formulary management programs customized for each partner we serve. We eliminate and/or minimize drug orders not related to terminal diagnosis. We offer therapeutic interchange options that provide additional cost savings and eliminate duplicate therapies. We also provide hospices with 24-hour access to our industry-leading reporting tools. OnePointRx™ is our internally designed, password-protected reporting suite providing hospices with unlimited access to a full-range of customized administrative, inancial and clinical reports, including a comprehensive Plan of Treatment (PoT) Report for every patient we serve. OnePointRx is available on any web-enabled PC, laptop, iPad, iPhone, Android or Blackberry mobile device. LOCAL HOSPICE PHARMACY CENTER OF EXCELLENCE Serving hospice programs for over 25 years, OnePoint Patient Care has developed systems and capabilities customized to the unique needs of hospice. We recruit, hire and retain the nation’s leading pharmacy professionals who specialize in hospice care and distinguish themselves with their knowledge of hospice medication, dosage conversions, interactions and drug-to-drug interactions. As part of our standard dispensing service we screen for the most clinically appropriate and cost-effective alternative therapies. Hospice care teams always have direct pharmacy contact with each call and we are properly staffed to exceed your service expectations. Our team is available to provide 24-hour clinical advice, support and therapeutic recommendations. It is important to us that we are able to provide you with the information you want at the time of the order. To this end, each staff member has a computer terminal, full patient proile and complete drug history at their ingertips when you call. In addition, when a patient is in need of immediate medication, we offer STAT service that ensures most orders are processed and delivered within two hours from a well-stocked local inventory of your custom formulary medications. We also offer Patient Care Kits for a patient’s home as well as narcotic and non-narcotic boxes for inpatient unit staff providing immediate access in times of emergencies. We are proud experts in drug compounding. We offer unique compounding solutions that meet the individual needs of each hospice patient we serve. Drug compounding is the customization of a drug requested by a physician that requires a speciic dosage or form not currently commercially available. Our compounding is performed by clinical experts and is customized according to a patient’s speciic need. Many hospice programs and patients realize there are a limited number of strengths and dosage forms commercially available for hospice care. Some commercially manufactured medications may not meet the precise needs of many hospice patients; therefore, the interest for hospice compounding has increased dramatically in providing superior end-of-life care. DELIVERY – Customer Care Specialists We refer to our delivery personnel as Customer Care Specialists because they deliver exceptional service to our hospice patients and their families. We employ and manage a local captive delivery organization specializing in prescription delivery. Each employed delivery representative is uniformed, identiiable with a name badge and is subject to a comprehensive background check, dress code and grooming policies. DIRECT TO HOME Our Customer Care Specialists proudly deliver hospice medications direct to each patient’s site 24 hours a day, 365 days a year, regardless of patient setting, including but not limited to the patient’s private home, long-term care facility or in-patient unit (IPU). We always call to verify all orders delivered after 8pm daily. The Hospice Pharmacy Services Provider For more information, please call us at 866.771.OPPC (6772) or email sales@oppc.com Or visit us online www.onepointpatientcare.com A Dedicated Hospice Pharmacy Our superior service model is founded on the simple principle that outstanding patient care can best be achieved when hospice pharmacy specialists screen and dispense medications locally and deliveries are made directly to patient sites by our own captive delivery personnel. We provide partners with both covered and non-covered medications (for hospice partners that qualify) for their hospice patients and we customize our service in ways that other pharmacies do not. Clinical Consulting and Drug Screening Our experienced clinical professionals offer detailed, immediate therapeutic consulting with every call. We offer hospices the unique ability to screen each patient’s drug therapy based on terminal diagnosis, and we screen for duplicate therapies. We offer hospices complete compliance with the latest hospice COPs (Conditions of Participation) related to the initial and comprehensive assessment of the patient as well as the entire patient drug therapy. We offer a robust library of in-service education programs for hospice team members and our clinical experts are happy to participate in hospice IDG (Inter-Disciplinary Group) meetings and offer CQI (Continuous Quality Improvement) team support. Cost Management (PBM/PBA) We offer medication management programs designed to provide superior, yet cost-effective, palliative care. Our clinicians provide comprehensive cost containment measures and hospice-speciic formulary management programs customized for each partner we serve. We eliminate and/or minimize drug orders not related to terminal diagnosis. We offer therapeutic interchange options that provide additional cost savings and eliminate duplicate therapies. $ OnePoint Patient Care is the nation’s leader in providing total hospice pharmacy services. We provide daily in-home deliveries from our local pharmacies in each market we serve. We’re different than any other national or local hospice pharmacy because of our RX AccuTrack® program. This means we specialize in hospice pharmacotherapy, offer exceptional clinical advice, provide cost management programs unique to each hospice partner, provide custom compounding solutions and deliver daily to each patient’s home, long-term-care facility or inpatient unit. A Dedicated Hospice Pharmacy Clinical Consulting Cost Management (PBM / PBA) Dispensing Delivery Direct to Home Phone: 866.771.OPPC (6772) Web: www.onepointpatientcare.com $ OPPC0000061 Opposition No. 91228995 Kirkland Affidavit Exh. 9 The Hospice Pharmacy Services Provider For more information, please call us at 866.771.OPPC (6772) or email sales@oppc.com Or visit us online www.onepointpatientcare.com Dispensing & Custom Compounding Serving the hospice market for over 20 years, OnePoint Patient Care has developed systems and capabilities customized to the unique needs of our hospice partners. We recruit, hire and retain the nation’s leading pharmacy professionals who specialize in hospice care and distinguish themselves with their knowledge of hospice medication, dosage conversions, interactions and alternative therapies. As part of our standard dispensing service, we screen for drug-to-drug interactions. Hospice care teams always have direct pharmacy contact with each call and are never placed into an electronic queue waiting to speak with a pharmacy representative. Our team is available to provide 24-hour clinical advice, support, and therapeutic recommendations. It is important to us that we are able to provide you with the information you want at the time of the order. To this end, each staff member has a computer terminal, full patient proile and drug history at their ingertips when you call. In addition, when a patient is in need of immediate medication, we offer STAT service that will get the order processed and delivered within two hours. We also offer customized Patient Care Kits for a patient’s home as well as narcotic and non-narcotic boxes for inpatient unit staff providing immediate access in times of emergencies. We are proud experts in drug compounding. We offer unique compounding solutions that meet the individual needs of each hospice patient we serve. Drug compounding is the customization of a drug requested by a physician that requires a speciic drug dosage or form not currently commercially available. Our compounding is performed by clinical experts and is customized according to a patient’s speciic need. Many hospice programs and patients realize there are a limited number of strengths and dosage forms commercially available for hospice care. Some commercially manufactured medications may not meet the precise needs of many hospice patients; therefore, the interest for hospice compounding has increased dramatically in providing superior palliative care. Delivery – Our Customer Care Specialists We refer to our delivery personnel as Customer Care Specialists because they deliver exceptional service to our hospice patients and their families. We employ and manage a local captive delivery organization specializing in prescription delivery. Each employed delivery representative is uniformed, identiiable with a name badge and is subject to a comprehensive background check, dress code and grooming policies. Direct To Home Our Customer Care Specialists proudly deliver hospice medications direct to each patient’s site 24 hours a day, 365 days a year, regardless of patient setting, including but not limited to the patients’ private homes, long-term-care facility and in-patient units (IPUs). We always call to verify all orders delivered after 8pm daily. OPPC0000062 Opposition No. 91228995 Kirkland Affidavit Exh. 9 OPPC0000014 Opposition No. 91228995 Kirkland Affidavit Exh. 10 OPPC0000015 Opposition No. 91228995 Kirkland Affidavit Exh. 10 OPPC0000016 Opposition No. 91228995 Kirkland Affidavit Exh. 10 When you have chosen an appropriate Horizon Pharma medication… HORIZONCARES HELPS PATIENTS GET THE MEDICATION THEY NEED QUICKLY AND AFFORDABLY References: 1. Partyka G, Plut EM. The patient experience–delivering personalized content. Presented at: Allscripts Client Experience 2014 conference (ACE14). Chicago, IL. 2014. 2. USA Today/Kaiser Family Foundation/Harvard School of Public Health. The Public on Prescription Drugs and Pharmaceutical Companies. March 2008. Kaiser Family Foundation website. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7748. pdf. Accessed August 17, 2016. 3. Data on file. Horizon Pharma USA, Inc. *HorizonCares calls 100% of patients when correct patient contact information is provided. †See Terms and Conditions on reverse side. 31% of patients never even go to the pharmacy1 29% do not fill their prescription due to cost2 HORIZONCARES CALLS OF PATIENTS* OF COMMERCIALLY INSURED PATIENTS PAY $10 OR LESS3 TYPICAL RETAIL PHARMACY OUTCOME HORIZONCARES OUTCOME PATIENT PHARMACY EXPERIENCE OUT-OF-POCKET COST FOR THE PATIENT Through HorizonCares,† Horizon Pharma will buy down qualifying Horizon medication co-pays to $10 or less for commercially insured patients. 100% >99% OPPC0000065 Opposition No. 91228995 Kirkland Affidavit Exh. 11 • Prescribes a qualifying Horizon Pharma product • E-Prescribe: OnePoint Patient Care-Chicago IL 8130 Lehigh Ave, Morton Grove, IL 60053 1-866-323-1490 NCPDP/NABP: 1482621 NPI:: 1912151515 • Fax: Please fax to 1-844-308-9412 ST EP 1 Patient: • Receives a phone call from Pharmacy within 24 hours ST EP 2 HorizonCares*: • Patient pays $0† for prescription, if commercially insured - Or, pays $10 if insurance does not approve - If applicable, a prior authorization may be needed • Prescription ships overnight at no cost • Call 1-866-323-1490 with questions or concerns ST EP 3 HOW HORIZONCARES WORKS Health Care Professional: *Terms and Conditions: Offer cannot be combined with any other rebate or coupon, free trial, or similar offer for the specifi ed prescription. Not valid for prescriptions reimbursed in whole or in part by Medicaid, Medicare, VA, DOD, TriCare, or other federal or state programs (including state prescription drug programs). Offer good only in the United States at participating retail pharmacies. Absent a change in Massachusetts law, offer not valid in Massachusetts after July 1, 2017. Offer not valid where otherwise prohibited by law. Horizon Pharma reserves the right to rescind, revoke, or amend offer without notice. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. This card is not insurance and is not intended to substitute for insurance. Participating patients and pharmacists understand and agree to comply with all Terms and Conditions of offer. Patients must be 18 or older. †Third fi ll may be $75, but $10 after a mail-in rebate. ©2016 Horizon Pharma USA, Inc. All rights reserved. December 2016. Printed in the U.S.A. P-hc-00024 www.horizonpharma.com OPPC0000066 Opposition No. 91228995 Kirkland Affidavit Exh. 11 HorizonCares Rx Connect FAQs Q 1: What is HorizonCares Rx Connect? A 1: HorizonCares Rx Connect is an enhanced way for your eligible commercially insured patients to access Horizon Pharma prescription medications in a more streamlined manner. By submitting your prescription request for qualifying Horizon Pharma products through HorizonCares Rx Connect you gain access to a single point-of-contact for these Horizon Pharma prescriptions, connecting your patient to a local pharmacy for medication dispensing and clinical support. Q 2: What are the benefits of using HorizonCares Rx Connect? A 2: Key benefits of using HorizonCares Rx Connect include: • 24/7/365 prescription intake support for all qualifying Horizon Pharma products for eligible patients • Single point-of-contact, connecting your patient to a HorizonCares local pharmacy • Patient specific insurance verification to determine coverage for qualifying Horizon Pharma products • Streamlined access to the HorizonCare’s commercial copay savings program for eligible patients Q 3: How do I begin to use HorizonCares Rx Connect? A 3: Accessing HorizonCares Rx Connect for qualifying Horizon Pharma products is as easy as 1-2-3. Simply: 1. E-prescribe or Fax to OnePoint Patient Cares, Chicago, IL 2. Notify your patient that they will receive a phone call from HorizonCares 3. Your eligible commercially insured patient will pay $10 or less for their Rx Q 4: How do I know when a prescription has been received by HorizonCares Rx Connect? A 4: If your initial “test” prescription transmission to HorizonCares Rx Connect is successful, you will receive a prescription receipt confirmation notice, which shall be issued in the form of a single-page FAX upon prescription receipt. Should you wish to continue to receive this confirmation, simply let your Horizon representative know or contact a HorizonCares Rx Connect representative directly at 866-323- 1490 to have this service turned on for your office. OPPC0000067 Opposition No. 91228995 Kirkland Affidavit Exh. 11 Q 5: I submitted a prescription request through HorizonCares Rx Connect. When will the dispensing pharmacy receive it? A 5: All prescriptions received by HorizonCares Rx Connect before 7 pm ET Monday – Friday will be processed and triaged to a participating local pharmacy that same day. All prescriptions received after 7 pm ET Monday – Friday will be handled the next business day. Q 6: Can I use HorizonCares Rx Connect for all the prescription needs for my patient, including medications not manufactured by Horizon? A 6: No. HorizonCares Rx Connect is available for qualifying Horizon Pharma products only. Q 7: What should I do if I have trouble accessing HorizonCares Rx Connect, or if I have more questions? A 7: Should you have any question regarding accessing HorizonCares Rx Connect, simply let your Horizon sales representative know or contact us directly at 866-323-1490. Our highly trained customer service advisors are available to address your questions 7 days a week. OPPC0000068 Opposition No. 91228995 Kirkland Affidavit Exh. 11 *See Terms & Conditions on reverse side. Your prescription has been sent to a HorizonCares* participating pharmacy COMMERCIALLY INSURED PATIENTS PAY $10 OR LESS IT’S EASY AS 1-2-3 1. Pharmacy will call you within 24 hours to confirm your insurance and address 2. Your prescription will be filled 3. Prescription will be delivered to you within 48 hours at no additional cost This program is sponsored by HorizonCares Rx Connect, supported by OnePoint Patient Care, Chicago, IL., which provides prescription access support to qualifying Horizon Pharma products to eligible patients. OPPC0000069 Opposition N . 91228995Kirkla d Affidavit Exh. 11 * Terms and Conditions: Offer cannot be combined with any other rebate or coupon, free trial, or similar offer for the specified prescription. Not valid for prescriptions reimbursed in whole or in part by Medicaid, Medicare, VA, DOD, TriCare, or other federal or state programs (including state prescription drug programs). Offer good only in the United States at participating retail pharmacies. Absent a change in Massachusetts law, offer not valid in Massachusetts after July 1, 2017. Offer not valid where otherwise prohibited by law. Horizon Pharma reserves the right to rescind, revoke, or amend offer without notice. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. This card is not insurance and is not intended to substitute for insurance. Participating patients and pharmacists understand and agree to comply with all Terms and Conditions of offer. Patients must be 18 or older. ©2017 Horizon Pharma USA, Inc. All rights reserved. January 2017. Printed in the U.S.A. P-hc-00029 www.horizonpharma.com OPPC0000070 Opposition No. 91228995Kirkland Affidavit Exh. 11 Copy with citationCopy as parenthetical citation
