2011_Amgen Enbrel Formulary Win - OBC Campaign New York Medicaid
Name: 


A red asterisk (*) indicates required questions.

  1. (Call Pre-Work- Copy of Paste from Spreadsheet). CMA ID # ?*


  1. (Call Pre-Work- Copy of Paste from Spreadsheet). Telephone Number?*


  1. (Call Pre-Work- Copy of Paste from Spreadsheet). Prescriber Name: First and Last?*


  1. Is this our first attempt to contact the MDO*
    Yes
    No (Left message for return call)


  1. Was the office contact available to talk?*
    Yes
    No (second attempt scheduled)


  1. (Skip if contact is available to talk)- What is the preferred time for follow-up? Any specific day requested? "You should receive a follow-up within 2 business days"


  1. Were you aware of the recent changes with New York Medicaid?
    Yes
    No


  1. Did you receive a letter from New York Medicaid regarding Enbrel requiring Prior Authorization?
    Yes
    No


  1. Are you familiar with the Enbrel Support Suite of Services?
    Yes
    No


  1. Do you currently have patients on Enbrel?
    Yes
    No


  1. Would you like our assistance in completing prior authorizations for your Enbrel patient enrolled in New York Medicaid?
    Yes We will have your Single point of contact, Your Enbrel Access Specialist contact you directly
    No