Call Simulation Game

Patient Hesitancy Practice

Read the following scheduling call scenarios and select the best responses to handle patient hesitency! Use the following tools to help determine the best options:

• Scheduling Call Script
• Patient Hesitancy Notes

Click the arrow to start!

Patient A: Diana Fosters

Alert: 8/15/24: $0 Copays. Med B Primary, ded met. AARP Plan F Supp covers coins/ded. APP Order: Yupelri, Budesonide, Formoterol and Disposable Cups & Tubing

Hello! This is Mary calling from your pharmacy DirectRx. Is this Ms. Diana Fosters I am speaking with?

Yes, speaking.

Hi, Ms. Fosters. I'm calling because it's time to schedule your breathing medications Yupelri, Budesonide, Formterol, and Disposable Cups & Tubing prescribed by Dr. Johns and wanted to confirm that 61598 Eureka Rd is the correct address?

I appreciate you calling but I have enough of my breathing meds.

No problem! We will call you next month.

How much of the Yupelri, Budesonide and Formoterol do you have left?

Choose the best reply:

Patient A: Diana Fosters

Alert: 8/15/24: $0 Copays. Med B Primary, ded met. AARP Plan F Supp covers coins/ded. APP Order: Yupelri, Budesonide, Formoterol and Disposable Cups & Tubing

How much of the Yupelri, Budesonide and Formoterol do you have left?

I have about a week left!

That is about what we would anticipate; it takes about 3-5 days to ship to you so we can ship it out today to ensure you will get it in time.

Ah ok, well go ahead and send it out!

GREAT JOB!Always make sure to confirm the quantity patient has on hand. Often patients think they have more than they should when scheduling the next delivery. We anticipate they should have around 1 week supply left.

Patient A: Diana Fosters

Alert: 8/15/24: $0 Copays. Med B Primary, ded met. AARP Plan F Supp covers coins/ded. APP Order: Yupelri, Budesonide, Formoterol and Disposable Cups & Tubing

No problem! We will call you next month.

Ok! You guys are so wonderful there. Thank you!

Patient A: Diana Fosters

Alert: 8/15/24: $0 Copays. Med B Primary, ded met. AARP Plan F Supp covers coins/ded. APP Order: Yupelri, Budesonide, Formoterol and Disposable Cups & Tubing

1 month later....

Hello! This is Mary calling from your pharmacy DirectRx. Is this Ms. Diana Fosters I am speaking with?

Yes!

Hi, Ms. Fosters. I'm calling because it's time to schedule your breathing medications Yupelri, Budesonide, Formterol, and Disposable Cups & Tubing and wanted to confirm that 61598 Eureka Rd is the correct address?

I am glad you called. I really need my meds. I haven't had any in 3 weeks. You need to rush this out now!!

Always make sure to confirm the quantity patient has on hand. Often patients think they have more than they should when scheduling the next delivery. We anticipate they should have around 1 week supply left. This eliminates shortages or the expense of last minute rushes!

Try Again!

Patient B: George Petricaj

Alert: 8/10/23: $278.44 Yup, $0.60 CT, $0.40 Filter. Medicare Part-B Primary Order: Yupelri, Disposable Cups & Tubing

Hello! This is Ann calling from your pharmacy DirectRx. Is this Mr. George Patricaj I am speaking with?

Yes, this is him!

Hi, Mr. Petricaj. I'm calling because it's time to schedule your breathing medications for Yupelri and Disposable Cups & Tubing prescribed by Dr. Lourdes and wanted to confirm that 615 E 2nd Ave is the correct address?

That's my address... go ahead and send them.

Do we have your permission to charge the card on file for your $279.44?

That can't be right. That's so expensive!

Let's double check that we have the right information on file! Is your insurance Medicare-Part B Primary?

We have billing and insurance specialists here who ensure this is the lowest possible cost. It's typically $1,100 without insurance so your plan is covering the majority of the cost.

Choose the best reply:

Patient B: George Petricaj

Alert: 8/10/23: $278.44 Yup, $0.60 CT, $0.40 Filter. Medicare Part-B Primary Order: Yupelri, Disposable Cups & Tubing

We have billing and insurance specialists who ensure that this is the lowest possible cost. It's typically $1,100 without insurance so your plan is covering the majority of the cost.

It's still too much. I can't afford that on my monthly income.

I understand....

... these medications can be costly. It is important to follow your doctor's regimen. Is it possible for you to try it for the month or is there anyone that can assist you with the costs?

... these medications can be costly. We can call you back in 3-4 weeks to see if maybe you are able to figure out another option?

Choose the best reply:

Patient B: George Petricaj

Alert: 8/10/23: $278.44 Yup, $0.60 CT, $0.40 Filter. Medicare Part-B Primary Order: Yupelri, Disposable Cups & Tubing

I understand these medications can be costly. We can call you back in 3-4 weeks to see if maybe you are able to figure out another option?

Okay, I won't have the funds then either though.

I understand Mr. Petricaj. However if anything changes please feel free to give us a call, otherwise we will call in 3-4 weeks and check in with you.

When patients indicate they cannot afford medication, we must do our best to show compassion and offer every option possible. It is important to help the patient figure out if there are any other options such as getting help from a family/friend for the month or even getting at least one of the medications (if there are multiple medications on order). This patient may be eligible for funding or there may be another regime more cost effective that their doctor can prescribe.

Try Again!

Patient B: George Petricaj

Alert: 8/10/23: $278.44 Yup, $0.60 CT, $0.40 Filter. Medicare Part-B Primary Order: Yupelri, Disposable Cups & Tubing

Let's double check that we have the right information on file. Is your insurance Medicare-Part B primary?

Yes, and I pay monthly for it!

Yes, a premium is paid monthly for your insurance services. However this plan also has a coinsurance which you are responsible for. The Yupelri without this plan is about $1,100 so your insurance is covering almost 80% of the cost.

Ah that's true. But still I can't afford that.

I understand...

It is important to follow the treatment plan prescribed by your doctor. I am concerned if you stop taking it. Is there someone that could help you this month to try it out? We also work with funding foundations that may be able to help on future orders with your copay.

... these medications can be costly. We can call you back in 3-4 weeks to see if maybe you are able to figure out another option?

Choose the best reply:

Patient B: George Petricaj

Alert: 8/10/23: $278.44 Yup, $0.60 CT, $0.40 Filter. Medicare Part-B Primary Order: Yupelri, Disposable Cups & Tubing

It is important to follow the treatment plan prescribed by your doctor. I am concerned if you are not taking it. Is there someone that could help you this month to try it out? We also work with funding foundations that may be able to help on future orders with your copay.

I don't have anyone that can help. If you know anything that can help with the payment I will take it.

Have you ever been diagnosed with COPD or Asmtha by a doctor?

Yes, COPD

We need information from you in order to apply for funding assistance. There may be waitlists for funding, but we will do our best to get you any assistance available. Do you have a few minutes to answer some questions so we can get the application started?

Yes, sounds good.

GREAT JOB!Applying for funding may be the last available option for the patient. Also, be sure to remind them to let their doctor know they are not taking their medications due to budget concerns and encourage them to find out if there are any other more cost effective options available.

Great!

Patient C: Henry Yanes

Alert: 4/01/24: $0 Yup, $0.60 CT, $0.40 Filter. Medicare Part-B Primary, Plan F AARP Order: Yupelri, Disposable Cups & Tubing

Hello! This is Ann calling from your pharmacy DirectRx. Is this Mr. Henry Yanes I am speaking with?

Speaking!!

Hi, Mr. Yanes. I'm calling because it's time to schedule your breathing medications for Yupelri and Disposable Cups & Tubing prescribed by Dr. Meridian and wanted to confirm that 394 Potomac Dr is the correct address?

That's my address but I don't need any right now..

How much of the Yupelri do you have?

Mr. Yanes. It looks like you should be running low. What's changed in your treatment plan?

Choose the best reply:

Patient C: Henry Yanes

Alert: 4/01/24: $0 Yup, $0.60 CT, $0.40 Filter. Medicare Part-B Primary, Plan F AARP Order: Yupelri, Disposable Cups & Tubing

How much of the Yupelri do you have left?

I have over a month left. Please call me then!

Have you been taking the medication as prescribed?

It looks like you should be running low, Mr. Yanes. How often are you taking the medication?

Choose the best reply:

Patient C: Henry Yanes

Alert: 4/01/24: $0 Yup, $0.60 CT, $0.40 Filter. Medicare Part-B Primary, Plan F AARP Order: Yupelri, Disposable Cups & Tubing

It looks like you should be running low, Mr. Yanes. How often are you taking the medication?

I take the Yupelri every day and it works wonders! I was in the hospital for about 3 weeks and just got out last week so I still have a lot left!!

I am glad to hear you're back home now. We will call back in about 3 weeks to check in on you and schedule the next delivery.

GREAT JOB!It is important to find out how much medication a patient has; explain they should be running low in stock if they have more than 1-2 weeks and attempt to find out what has changed. Open ended questions are a great way to get more information from a patient when needed!

Great!

Patient C: Henry Yanes

Alert: 4/01/24: $0 Yup, $0.60 CT, $0.40 Filter. Medicare Part-B Primary, Plan F AARP Order: Yupelri, Disposable Cups & Tubing

Have you been taking the medication as prescribed?

Yes, of course. Just give me a call next month. I do not need any right now.

It is important to take your medication regularly; so it can build up in your system. We recommend following your doctor's instructions for best results which is to take the Yuperli once daily.

It looks like you should be low in stock now. Has anything changed in your treatment plan?

Choose the best reply:

Patient C: Henry Yanes

Alert: 4/01/24: $0 Yup, $0.60 CT, $0.40 Filter. Medicare Part-B Primary, Plan F AARP Order: Yupelri, Disposable Cups & Tubing

It is important to take your medication regularly; so it can build up in your system. We recommend following your doctor's instructions for best results.

PATIENT HANGS UP

I already know that. Just call me next month.

It is important to find why the patient has more medication left than anticipated. Most patients will say "Yes" if you ask if they are following their provider instructions so it is best to use open ended questions to determine their current usage/habits.

Try Again!

Patient C: Henry Yanes

Alert: 4/01/24: $0 Yup, $0.60 CT, $0.40 Filter. Medicare Part-B Primary, Plan F AARP Order: Yupelri, Disposable Cups & Tubing

It looks like you should be low in stock now. Has anything changed in your treatment plan?

PATIENT HANGS UP

No I am all good. Just call me next month.

It is important to find why the patient has more medication left than anticipated. Most patients will say "Yes" if you ask if they are following their provider instructions so it is best to use open ended questions to determine their current usage/habits.

Try Again!

Patient D: Lori Phillips

Alert: 3/01/24: $0 Ohtuvayre & supplies. Medicare Part-B Primary, Plan F AARP Order: Ohtuvayre, Pari Cups & Tubing

Hello! This is Ann calling from your pharmacy DirectRx. Is this Ms. Lori Phillips I am speaking with?

Yes, this is her.

Hi, Ms. Philiips. I'm calling because it's time to schedule your breathing medications for Yupelri and Disposable Cups & Tubing prescribed by Dr. Johansen and wanted to confirm that 2484 Whitley Dr is the correct address?

Oh, I have more than enough. But thank you for calling..

Ms. Phillips, It looks like you should be running low. How much of the Ohtuvayre do you have left?

Ok, you should be ready for a refill. Is your doctor aware of any changes to your treatment plan?

Choose the best reply:

Patient D: Lori Phillips

Alert: 3/01/24: $0 Ohtuvayre & supplies. Medicare Part-B Primary, Plan F AARP Order: Ohtuvayre, Pari Cups & Tubing

Ms. Phillips, It looks like you should be running low. How much of the Ohtuvayre do you have left?

I have over a month left, plenty to go.

Are you taking your medication as prescribed?

Has there been any changes in your treatment plan?

Choose the best reply:

Patient D: Lori Phillips

Alert: 3/01/24: $0 Ohtuvayre & supplies. Medicare Part-B Primary, Plan F AARP Order: Ohtuvayre, Pari Cups & Tubing

Ok, you should be ready for a refill. Is your doctor aware of any changes to your treatment plan?

PATIENT HANGS UP

No, and I am feeling fine. You can just call me back in a month..

It is important to ask open ended questions to find out patient experiences and be sure to listen and not assume!

Try Again!

Patient D: Lori Phillips

Alert: 3/01/24: $0 Ohtuvayre & supplies. Medicare Part-B Primary, Plan F AARP Order: Ohtuvayre, Pari Cups & Tubing

Are you taking your medication as prescribed?

Yes, I am fine like I said. Just call me next month. Thanks..

Ok, thank you for letting us know we will call back soon.

Ms. Phillips it shows you should be running pretty low now. Has there been any changes in your treatment plan?

Choose the best reply:

Patient D: Lori Phillips

Alert: 3/01/24: $0 Ohtuvayre & supplies. Medicare Part-B Primary, Plan F AARP Order: Ohtuvayre, Pari Cups & Tubing

Are you taking your medication as prescribed?

Yes, I am fine like I said. Just call me next month. Thanks..

Ok, thank you for letting us know we will call back soon.

Ms. Phillips it shows you should be running pretty low now. Has there been any changes in your treatment plan?

Choose the best reply:

Patient D: Lori Phillips

Alert: 3/01/24: $0 Ohtuvayre & supplies. Medicare Part-B Primary, Plan F AARP Order: Ohtuvayre, Pari Cups & Tubing

Ok, you should be ready for a refill. Is your doctor aware of any changes to your treatment plan?

No changes. I am doing just fine and feeling well.

How much do you have left so we know when to call back and check in? It's important to take this regularly.

Ok, thank you for letting us know we will call back soon.

Choose the best reply:

Patient D: Lori Phillips

Alert: 3/01/24: $0 Ohtuvayre & supplies. Medicare Part-B Primary, Plan F AARP Order: Ohtuvayre, Pari Cups & Tubing

Ok, thank you for letting us know we will call back soon.

Thank you so much, you guys are awesome!

It is important to ask open ended, probing questions from the beginning to understand a patient's story. Once we find out more about the patient and why they are not ready for a refill, we can address and educate the patient appropriately.

Try Again!

Patient D: Lori Phillips

Alert: 3/01/24: $0 Ohtuvayre & supplies. Medicare Part-B Primary, Plan F AARP Order: Ohtuvayre, Pari Cups & Tubing

How much do you have left so we know when to call back and check in? It's important to take this regularly.

I have about a month left. Thank you so much!

It is important to ask open ended, probing questions from the beginning to understand a patient's story. Once we find out more about the patient and why they are not ready for a refill, we can address and educate the patient appropriately.

Try Again!

Patient D: Lori Phillips

Alert: 3/01/24: $0 Ohtuvayre & supplies. Medicare Part-B Primary, Plan F AARP Order: Ohtuvayre, Pari Cups & Tubing

Has there been any changes in your treatment plan?

No, I take it when I need it and I have been feeling pretty good.

I am glad to hear you're feeling good! This is a maintenance medication though, so it should be used regularly in order to build up in your system. Ohtuvayre should be taken twice daily.

Ok, thank you for letting us know we will call back soon.

Choose the best reply:

Patient D: Lori Phillips

Alert: 3/01/24: $0 Ohtuvayre & supplies. Medicare Part-B Primary, Plan F AARP Order: Ohtuvayre, Pari Cups & Tubing

I am glad to hear you're feeling good! This is a maintenance medication though, so it should be used regularly in order to build up in your system. Ohtuvayre should be taken twice daily.

Ah ok, twice? I didn't realize that. I'll make sure to take it as I should from now on..

GREAT JOB!When patients have an excess supply of medication it is important to determine how much they have and how often they are taking that medication because they may be confused on the prescription instructions.

Patient E: Gerald Manley

Alert: 2/01/24: 09/06/2024 $3.82 Albuterol, $282.27 Yupelri, $173.48 Formoterol, $15 Nebulizer, $0.60 Tubing (D), $0.30 Mask. Humana Med Adv Primary Order: Albuterol, Yupelri, Formoterol, Disposable Cups + Tubing

Hello! This is Ann calling from your pharmacy DirectRx. Is this Mr. Manley I am speaking with?

Yes, it is.

Hi, Mr. Manley. I'm calling because it's time to schedule your breathing medications for Albuterol, Formoterol Yupelri and Disposable Cups & Tubing prescribed by Dr. Smith and wanted to confirm that 243 S Donahue Rd is the correct address?

That is correct.

Patient E: Gerald Manley

Alert: 2/01/24: 09/06/2024 $3.82 Albuterol, $282.27 Yupelri, $173.48 Formoterol, $15 Nebulizer, $0.60 Tubing (D), $0.30 Mask. Humana Med Adv Primary Order: Albuterol, Yupelri, Formoterol, Disposable Cups + Tubing

Thank you! Do we have permission to use the card on file for the medication copay? The total cost is $459.57

WOW! That's a lot, I can't believe it's that much! .

This is the total cost for all the medications and supplies. Just to confirm, is Humana Medicare Advantage your primary insurance?

I understand.Have you considered applying for funding to help with copay cost?

Choose the best reply:

Patient E: Gerald Manley

Alert: 2/01/24: 09/06/2024 $3.82 Albuterol, $282.27 Yupelri, $173.48 Formoterol, $15 Nebulizer, $0.60 Tubing (D), $0.30 Mask. Humana Med Adv Primary Order: Albuterol, Yupelri, Formoterol, Disposable Cups + Tubing

I understand.Have you considered applying for funding to help with copay cost?

I am not familiar with that..

It can help with copay costs. We just need to go through a questionaire to find out some information and find the best option for you.

I don't have time right now, maybe next time..

No problem! We can try in a few weeks again. Have a nice day!

When patients are concerned about copay costs, it is important to verify their insurance and remind them of their coverage. Also, do not assume they cannot afford the medication until they verbalize this as it is normal to expect some patients will be unhappy with costs even though they plan to pay them!

Try Again!

Patient E: Gerald Manley

Alert: 2/01/24: $0, Bud, Arfor Medicare Part-B Primary, Plan F BCBS Order: Yupelri, Budesonide

This is the total cost for all the medications and supplies. Just to confirm, is Humana Medicare Advantage your primary insurance?

Yes, I just can't believe how expensive these are..

Ok, you should be ready for a refill. Is your doctor aware of any changes to your treatment plan?

I understand. Some of these medications are very costly- in fact, before your insurance the Yupelri alone is $1,100 so it looks like your insurance is covering about 80% of that medication.

Choose the best reply:

Patient E: Gerald Manley

Alert: 2/01/24: $0, Bud, Arfor Medicare Part-B Primary, Plan F BCBS Order: Yupelri, Budesonide

I understand. Some of these medications are very costly- in fact, before your insurance the Yupelri alone is $1,100 so it looks like your insurance is covering about 80% of that medication.

Yes, I just can't believe how expensive these are. Go ahead and the charge the card, just wish this was cheaper!

GREAT JOB!When patients voice concern over cost, make sure to verify insurance and discover whether they are venting about cost or truly cannot afford it. We can expect patients to dislike the costs but we cannot assume that means they do not have the funds to pay for it.

Ms. Phillips it shws you should be running pretty low now. Has there been any changes in your treatment plan?

Tips for Handling Patient Hesitancy

• Ask probing questions - make sure to ask questions if/when responses don't make sense.
• The use of open-ended questions can often help to get more accurate answers (e.g., when was the last time you changed your cups and tubing?)
• Watch your tone of voice and make sure to align with patients' needs.
• LISTEN.
• Be prepared to repeat questions (sometimes with different wording) or responses to patients' concerns.
• We always need to know how much medication a patient has on hand, and if there is more than 1-2 weeks, we need to know WHY they have more than anticipated.
• We always need to know if a doctor is aware of changes to a treatment plan.