Wolfson*
Shaw
Heasley
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 STAN SNEERINGER
Address PEDERSEN & HOUPT
161 N CLARK STREET , SUITE 2700
CHICAGO, IL 60601
UNITED STATES
Email: [email protected], [email protected],
[email protected]
Submission Testimony For Plaintiff
Filer’s Name Stanley C. Sneeringer
Filer’s email [email protected], [email protected],
[email protected]
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 )
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
COLOR CODE REFERENCE CHART
7am – 10am Pink 8pm – 10pm Gray
11am – 1pm Yellow 11pm – 6am Purple
2pm – 4pm Green PRN Red
5pm – 7pm Orange Controlled Blue
Time Pass Checklist:
1. Refer to Medication Administration Record (MAR)
2. Open the medication cart drawer for the residents 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. ***
ALCCRC.AZ.0208
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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
OneConnectPoint is an
of the hospice industry, OneConnectPoint simplifies the admission and invaluable tool. The app
allows me to see what
medication ordering process to reduce the time clinicians spend dealing
has been ordered for any
with pharmacy and ultimately increase the time they have available to patient, saving phone calls to
nurses, the pharmacy and patients.
spend caring for their patients.
Connie, RN
Our simple, seamless and secure technology allows Hospice of the Valley – Arizona
our hospice partners to: Download your FREE
Quickly admit and update patients Create a Prior Authorization for a OneConnectPoint App today
demographics and medication profiles non-formulary medication while placing
Place refill and new medication orders an order
through our integrated e-Rx platform Ability to receive medication profiles
Track the delivery status of a from eMRs Apple, the Apple logo, iPad, are trademarks of Apple Inc.,
medication order Receive Notifications indicating registered in the U.S. and other countries. App Store is a
Verify medication orders real time Prior Authorizations and E-Rx orders service mark of Apple Inc., registered in the U.S. and other
against the hospice formulary, as well pending approval countries.
as screen for drug Interactions
Google Play and the Google Play logo are trademarks of
Google Inc.
For more information, please contact us:
866.771.OPPC (6772) [email protected]
Visit OnePoint Patient Care online:
www.oppc.com
Opposition No. 91228995 Kirkland Affidavit Exh. 3
OPPC0000030
Phone: 866.771.OPPC (6772)
Web: onepointpatientcare.com
ORDER RECEIVED
Your Patient. Your Time.
Instant Prescription Access.
INTRODUCING ONEPOINT PATIENT CARES MOBILE APPLICATION.
Our versatile mobile app delivers an unprecedented level of The Patient Care App is an
invaluable tool. The app
information integration. It streamlines the process so data is allows me to see what has
entered only once for your patients admission, prescription been ordered for any patient,
saving phone calls to nurses,
ordering and clinical management needs. You receive real-time
the pharmacy and patients.
updates to track orders, changes and prescription proile CONNIE, RN
information right from your Windows, Apple, Android device HOSPICE OF THE VALLEY ARIZONA
or your PC.
I can now order medications,
proile orders for future
OUR SIMPLE, SEAMLESS AND SECURE TECHNOLOGY PLATFORMS dispensing and check on
ALLOW YOU TO: order status, all on my
Save time and money with Make informed clinical schedule, from a single,
instant patient information medication decisions integrated app.
access AMY, RN MANAGER
Use OnePointRx to see
Take control of the ordering therapeutic alternative IU HEALTH VNA HOSPICE INDIANA
experience considerations
Know the status of the order Simplify ordering and
in real time proiling information for Download your
new orders and reills, FREE Patient Care
Issue prior authorizations
including controlled Mobile App today at
substances https://mobile.oppc.com
Opposition No. 91228995 Kirkland Affidavit Exh. 3
OPPC0000063
Experience the difference
when patients come first.
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
We understand what is important to you and your patients.
Were a national hospice pharmacy As an integrated pharmacy & PBM,
that owns & controls our own admitting patients and placing
pharmacies utilizing our exclusive medication orders is just one easy
Rx AccuTrack® quality control process. phone call away.
Were employee-owned and report Were technology leaders providing
directly to our hospice partners and and enabling e-Prescribing for
their patients, not shareholders or controlled substances, mobile tools
private equity investors. and real-time data exchange.
Our pharmacists customize preferred Our exclusive reporting system,
drug lists (PDLs) and provide OnePointRx gives you the tools to
formulary/PDL management programs completely align your clinical objectives
speciic to each hospice we serve. with inancial goals and benchmarks.
To learn more, call us at 866.771.OPPC (6772)
Opposition No. 91228995 or email
Kirkland Affidavit Exh. 4 [email protected]
www.onepointpatientcare.com
OPPC0000003
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Partnering for Premier Pharmacy Services
XYZ Hospice
Month XX, 2017
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 1
Agenda
The OnePoint Difference
A Solution That Adds Up
Transition & Account Management
Next Steps
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 2
The OnePoint Difference
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 3
4
What Can One Do For You?
Were unique in that were 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 Daily ADC of Over 30,000
providers. Processing Over
200,000 Rxs/month
Nationwide Dispensing
and Delivery Capabilities
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 4
OnePoints History
1. Founded in 10. In 2015, 11. In 2015,
1965 as began serving introduced
Professional 6. In 2008, Colorado from new logo and
Pharmacy continued our new tagline
national Denver
4. In 2005, 5. Began expansion by
2. Began pharmacy
rebranded as serving Las serving OK,
serving OnePoint Vegas FL, and IL
Arizona Patient Care hospices in hospices
hospices under new
in 1986 2007 as our
ownership first
expansion
market
3. In 1995,
consolidated 12. Today we serve over
into a single 200 programs and
pharmacy, over 30,000
focused on patients/day in 26
hospice states and counting
8. Opened our 9. In 2014,
Vancouver, expanded to
WA pharmacy Detroit, MI
7. Launched
in 2012
Clinical
Consulting
and hospice-
only PBM
capabilities in OPPC OPPC
2008 Locations Serviced
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 5
OnePoint Proudly Serves Many of
the Nations Leading Hospices
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 6
Attentive, Flexible & Forward Thinking
T e c hnology
Sc a le
Le a de rship
EM R Ada pt a bilit y
I nt e gra t ion Fle x ibilit y
Cust om iza t ion
Priva t e ly
Ow ne d & Re t e nt ion
Ope ra t e d
Ac t ive Low e r
Ac c ount Cost
M a na ge m e nt Solut ions
Full Suit e
of
Solut ions
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 7
We Embed and Promote a Superior
Service Culture in All That We Do
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.
Professionalism, personal accountability and integrity are at the core of
Opposition who we are and whatKirkland
No. 91228995 we do, every
Affidavit Exh. hour
5 of every day OPPC0000078
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 8
A Solution That Adds Up
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 9
OnePoints Solutions Portfolio Creates the
Most Flexible Service Model for Hospice
Supe rior
H ospic e One Point Out c om e s,
I nsight Solut ions Profit a bilit y
& Opt ions
Greater control An adaptive Better patient
in a continually service model outcomes
changing designed to achieved with
environment meet unique profitability &
hospice needs control
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 10
Hospices Face More Challenges
Than Ever Before H ospic e
I nsight
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
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 11
Solutions that Allow Hospice to
Choose What They Need One Point
Solut ions
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.
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 12
Concierge PBM One Point
Solut ions
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
We know
Opposition No. that no
91228995 two hospices areAffidavit
Kirkland the same,
Exh. 5 so we act accordingly
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 13
A Custom Preferred Drug List Created with
Your Clinical Team, Managed By OnePoint One Point
Solut ions
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 14
Next Day Valet: Mail Order One Point
Solut ions
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 15
Next Day Valet: Mail Order One Point
Solut ions
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)
We create
Opposition a positive,
No. 91228995 memorable service
Kirkland Affidavit experience
Exh. 5 with each call
OPPC0000086
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 16
Direct Express: Local Service One Point
Solut ions
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
A hospice
Opposition pharmacy
No. 91228995 that cares forAffidavit
Kirkland your patients
Exh. 5 as much as you do
OPPC0000087
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 17
Integrated Care Solutions One Point
Solut ions
M obile I nt e grat ion w it h
& De sk t op H ospic e M a na ge m e nt
App Syst e m s
Tailored to Hospice Needs ADT interfaces
Enable CoP Compliance New customer
Puts cost management on-boarding
tools in hospices hands CR8358 Data
Online Reporting
Patient profile
management
Refill orders
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 18
OneConnectPoint Reporting Provides
Real-Time Access to Patient Data One Point
Solut ions
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
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 19
OneConnectPoint: Tools & Features One Point
Solut ions
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 20
CMS CR 8358 One Point
Solut ions
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 has
Opposition No. committed to ADT
91228995 EMR
Kirkland interfacing
Affidavit Exh. 5 with all major vendors
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 21
Supe rior
Benefits to Hospice Out c om e s,
Profit a bilit y
& Cont rol
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
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 22
Transition & Account Management
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 23
All Solutions Enjoy Active
Transition & Account Management Tra nsit ion
& Ac c ount
M a na ge m e nt
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
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© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 24
The OnePoint Difference
One
Ca ll
One
Com pe t it ive One
Adva nt a ge Pa rt ne r
One One
Re sourc e Pric e
One One
Com m it m e nt Le a de r
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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 nations 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 patients entire drug regimen. OnePoints 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 patients 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.
1
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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, its 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) Im 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?
Its extremely unlikely. If your medication expenses (co-pays and deductibles) are
currently covered under a nationally recognized and commercially available insurance
program, then its 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
2
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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
its difficult to list each one individually. Its 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 its 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?
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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. Were not always going to be able to match everyones 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?
Its 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?
Its 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?
4
Opposition No. 91228995 Kirkland Affidavit Exh. 7 OPPC0000050
NHM.FAQ.AZ.051209
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.
5
Opposition No. 91228995 Kirkland Affidavit Exh. 7 OPPC0000051
NHM.FAQ.AZ.051209
OnePoint Patient Care
Explanation of Pharmacy Services
Dear Patient, Family Member or Primary Caregiver:
OnePoint Patient Care is your hospice providers 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 patients 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 Pharmacys 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.
Opposition No. 91228995 Kirkland Affidavit Exh. 7
NHM.OLTP.052209
OPPC0000053
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000031
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000032
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000033
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000034
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000035
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000036
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000037
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
ALAF.AZ.02.08
OPPC0000038
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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: __________________
ALCCAF.AZ.0608
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000041
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
ALNPIF.AZ.0208
OPPC0000043
3006 S. Priest Drive Phone: (480) 240-1111
Tempe, AZ 85282 Fax: (480) 240-1112
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
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000045
NHM.AUTH.AZ.050509
3006 S. Priest Drive Phone: (480) 240-1111
Tempe, AZ 85282 Fax: (480) 240-1112
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: __________________
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000046
NHM.CCAUTH.AZ.031109
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 nations 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 patients entire drug regimen. OnePoints 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 patients 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.
1
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000047
NHM.FAQ.AZ.051209
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, its 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) Im 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?
Its extremely unlikely. If your medication expenses (co-pays and deductibles) are
currently covered under a nationally recognized and commercially available insurance
program, then its 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
2
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000048
NHM.FAQ.AZ.051209
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
its difficult to list each one individually. Its 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 its 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?
3
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000049
NHM.FAQ.AZ.051209
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. Were not always going to be able to match everyones 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?
Its 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?
Its 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?
4
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000050
NHM.FAQ.AZ.051209
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000031
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000032
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000033
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000034
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000035
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000036
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000037
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
ALAF.AZ.02.08
OPPC0000038
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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: __________________
ALCCAF.AZ.0608
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000040
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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: __________________
ALCCAF.AZ.0608
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000041
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
ALNPIF.AZ.0208
OPPC0000043
3006 S. Priest Drive Phone: (480) 240-1111
Tempe, AZ 85282 Fax: (480) 240-1112
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
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000045
NHM.AUTH.AZ.050509
3006 S. Priest Drive Phone: (480) 240-1111
Tempe, AZ 85282 Fax: (480) 240-1112
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: __________________
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000046
NHM.CCAUTH.AZ.031109
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 nations 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 patients entire drug regimen. OnePoints 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 patients 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.
1
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000047
NHM.FAQ.AZ.051209
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, its 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) Im 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?
Its extremely unlikely. If your medication expenses (co-pays and deductibles) are
currently covered under a nationally recognized and commercially available insurance
program, then its 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
2
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000048
NHM.FAQ.AZ.051209
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
its difficult to list each one individually. Its 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 its 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?
3
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000049
NHM.FAQ.AZ.051209
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. Were not always going to be able to match everyones 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?
Its 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?
Its 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?
4
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000050
NHM.FAQ.AZ.051209
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.
5
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000051
NHM.FAQ.AZ.051209
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 patients 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 Pharmacys 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 patients 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 patients third party
insurance will NOT be processed at OnePoint Patient Care without prior authorization. We will contact the
patients physician for a prior authorization. If we are unable to get the prior authorization, we will contact
you for the patients 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
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000052
OnePoint Patient Care
Explanation of Pharmacy Services
Dear Patient, Family Member or Primary Caregiver:
OnePoint Patient Care is your hospice providers 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 patients 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 Pharmacys 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.
Opposition No. 91228995 Kirkland Affidavit Exh. 8
NHM.OLTP.052209
OPPC0000053
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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 physicians 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.
1
Opposition
ALNOPP..AZ.0208
No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000054
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 persons
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 persons 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: ___________
2
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000055
ALNOPP..AZ.0208
ONEPOINT PATIENT CARES
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 OnePoints
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. OnePoints 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
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000056
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
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000057
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
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000058
The only national hospice pharmacy
capable of providing local deliveries to
your patients daily within hours!
Custom-designed dispensing
and delivery models including
OnePoint Local Pharmacy and
Mail Order Pharmacy services
Transparent, cost-plus
Pharmacy Beneits Manageme
(PBM) services for national,
multi-regional and stand-alon
hospices
25 years of clinical expertise
Hospice management integrat
E-prescribing capabilities via
our Patient Care App
Were 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.
To learn more please call us
at 866.771.OPPC (6772)
or email
Opposition No. 91228995 Kirkland Affidavit 9 @ oppc.com
Exh. sales
www.onepointpatientcare.com
OPPC0000001
Phone: 866.771.OPPC (6772)
Web: www.onepointpatientcare.com
OnePoint Patient Care is the nations 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.
Were 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 Clinical Consulting Clinical Management Local Hospice Delivery Direct to
Pharmacy and Drug Screening Solutions Pharmacy Center of Home
(PBM/PBA) Excellence
A DEDICATED HOSPICE PHARMACY CLINICAL CONSULTING AND DRUG SCREENING
Our superior service model is founded on the Our experienced clinical professionals offer
simple principle that outstanding patient care can best detailed, immediate therapeutic consulting with
be achieved when hospice pharmacy specialists screen every call. We offer hospices the unique ability to
and dispense medications locally and deliveries are screen each patients drug therapy based on terminal
made in a timely manner direct to patient sites by our diagnosis, and we screen for duplicate therapies. We
own captive delivery personnel. As a dedicated hospice offer hospices complete compliance with the latest
pharmacy, were willing and capable of customizing hospice COPs (Conditions of Participation) related to
a formulary for each hospice program we serve. the initial and comprehensive assessment of the patient
We believe that every hospice has unique clinical as well as the entire patient drug therapy. We offer
and inancial needs; therefore, hospices should utilize a robust library of in-service education programs for
their own unique formulary allowing them to achieve hospice team members and our clinical experts are
their individual objectives. Our clinical professionals happy to participate in hospice IDG (Inter-Disciplinary
have the experience and knowledge required to assist Group) meetings and offer CQI (Continuous Quality
you in the creation of a distinct formulary designed Improvement) team support.
exclusively for your patients and hospice program.
The Hospice Pharmacy Services Provider
CLINICAL MANAGEMENT SOLUTIONS (PBM/PBA) We also offer Patient Care Kits for a patients home
We offer medication management programs as well as narcotic and non-narcotic boxes for
designed to provide superior, yet cost-effective, end- inpatient unit staff providing immediate access in
of-life care. Our clinicians provide comprehensive cost- times of emergencies.
containment measures and hospice-speciic formulary
We are proud experts in drug compounding. We
management programs customized for each partner
offer unique compounding solutions that meet the
we serve. We eliminate and/or minimize drug orders
individual needs of each hospice patient we serve.
not related to terminal diagnosis. We offer therapeutic
Drug compounding is the customization of a drug
interchange options that provide additional cost savings
requested by a physician that requires a speciic
and eliminate duplicate therapies. We also provide
dosage or form not currently commercially available.
hospices with 24-hour access to our industry-leading
Our compounding is performed by clinical experts and
reporting tools. OnePointRx is our internally designed,
is customized according to a patients speciic need.
password-protected reporting suite providing hospices
Many hospice programs and patients realize there
with unlimited access to a full-range of customized
are a limited number of strengths and dosage forms
administrative, inancial and clinical reports, including
commercially available for hospice care. Some
a comprehensive Plan of Treatment (PoT) Report for
commercially manufactured medications may not meet
every patient we serve. OnePointRx is available on
the precise needs of many hospice patients; therefore,
any web-enabled PC, laptop, iPad, iPhone, Android or
the interest for hospice compounding has increased
Blackberry mobile device.
dramatically in providing superior end-of-life care.
LOCAL HOSPICE PHARMACY CENTER OF EXCELLENCE
DELIVERY Customer Care Specialists
Serving hospice programs for over 25 years,
We refer to our delivery personnel as Customer
OnePoint Patient Care has developed systems and
Care Specialists because they deliver exceptional service
capabilities customized to the unique needs of hospice.
to our hospice patients and their families. We employ
We recruit, hire and retain the nations leading and manage a local captive delivery organization
pharmacy professionals who specialize in hospice care specializing in prescription delivery. Each employed
and distinguish themselves with their knowledge of delivery representative is uniformed, identiiable with
hospice medication, dosage conversions, interactions a name badge and is subject to a comprehensive
and drug-to-drug interactions. As part of our standard background check, dress code and grooming policies.
dispensing service we screen for the most clinically
appropriate and cost-effective alternative therapies. DIRECT TO HOME
Hospice care teams always have direct pharmacy Our Customer Care Specialists proudly deliver
contact with each call and we are properly staffed hospice medications direct to each patients site 24
to exceed your service expectations. Our team is hours a day, 365 days a year, regardless of patient
available to provide 24-hour clinical advice, support setting, including but not limited to the patients private
and therapeutic recommendations. home, long-term care facility or in-patient unit
(IPU). We always call to verify all orders delivered after
It is important to us that we are able to provide you
8pm daily.
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
For more information, please call us at
orders are processed and delivered within two hours
866.771.OPPC (6772) or email [email protected]
from a well-stocked local inventory of your custom
formulary medications. Or visit us online www.onepointpatientcare.com
Phone: 866.771.OPPC (6772)
Web: www.onepointpatientcare.com
OnePoint Patient Care is the nations leader in providing total hospice pharmacy services.
We provide daily in-home deliveries from our local pharmacies in each market we serve.
Were 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 patients home, long-term-care facility or inpatient unit.
$
A Dedicated Clinical Cost Dispensing Delivery Direct to
Hospice Consulting Management Home
Pharmacy (PBM / PBA)
A Dedicated Hospice Pharmacy as well as the entire patient drug therapy. We offer
Our superior service model is founded on the a robust library of in-service education programs for
simple principle that outstanding patient care can best hospice team members and our clinical experts are
be achieved when hospice pharmacy specialists screen happy to participate in hospice IDG (Inter-Disciplinary
and dispense medications locally and deliveries are made Group) meetings and offer CQI (Continuous Quality
directly to patient sites by our own captive delivery Improvement) team support.
personnel. We provide partners with both covered and
non-covered medications (for hospice partners that Cost Management (PBM/PBA)
$
qualify) for their hospice patients and we customize our We offer medication management programs
service in ways that other pharmacies do not. designed to provide superior, yet cost-effective,
palliative care. Our clinicians provide comprehensive cost
Clinical Consulting and Drug Screening containment measures and hospice-speciic formulary
Our experienced clinical professionals offer management programs customized for each partner
detailed, immediate therapeutic consulting with we serve. We eliminate and/or minimize drug orders
every call. We offer hospices the unique ability to not related to terminal diagnosis. We offer therapeutic
screen each patients drug therapy based on terminal interchange options that provide additional cost savings
diagnosis, and we screen for duplicate therapies. We and eliminate duplicate therapies.
offer hospices complete compliance with the latest
hospice COPs (Conditions of Participation) related to
the initial and comprehensive assessment of the patient
Opposition No. 91228995 Kirkland Affidavit Exh. 9
OPPC0000061
The Hospice Pharmacy Services Provider
Dispensing & Custom Compounding individual needs of each hospice patient we serve. Drug
Serving the hospice market for over 20 years, compounding is the customization of a drug requested by
OnePoint Patient Care has developed systems and a physician that requires a speciic drug dosage or form
capabilities customized to the unique needs of our not currently commercially available. Our compounding
hospice partners. is performed by clinical experts and is customized
according to a patients speciic need. Many hospice
We recruit, hire and retain the nations leading
programs and patients realize there are a limited number
pharmacy professionals who specialize in hospice care
of strengths and dosage forms commercially available
and distinguish themselves with their knowledge of
for hospice care. Some commercially manufactured
hospice medication, dosage conversions, interactions and
medications may not meet the precise needs of many
alternative therapies. As part of our standard dispensing
hospice patients; therefore, the interest for hospice
service, we screen for drug-to-drug interactions. Hospice
compounding has increased dramatically in providing
care teams always have direct pharmacy contact with
superior palliative care.
each call and are never placed into an electronic queue
waiting to speak with a pharmacy representative. Our
Delivery Our Customer Care Specialists
team is available to provide 24-hour clinical advice,
We refer to our delivery personnel as Customer
support, and therapeutic recommendations.
Care Specialists because they deliver exceptional
It is important to us that we are able to provide you with service to our hospice patients and their families. We
the information you want at the time of the order. To employ and manage a local captive delivery organization
this end, each staff member has a computer terminal, specializing in prescription delivery. Each employed
full patient proile and drug history at their ingertips delivery representative is uniformed, identiiable
when you call. with a name badge and is subject to a comprehensive
background check, dress code and grooming policies.
In addition, when a patient is in need of immediate
medication, we offer STAT service that will get the order
Direct To Home
processed and delivered within two hours.
Our Customer Care Specialists proudly deliver
We also offer customized Patient Care Kits for a hospice medications direct to each patients site 24
patients home as well as narcotic and non-narcotic hours a day, 365 days a year, regardless of patient
boxes for inpatient unit staff providing immediate setting, including but not limited to the patients private
access in times of emergencies. homes, long-term-care facility and in-patient units
(IPUs). We always call to verify all orders delivered
We are proud experts in drug compounding. We
after 8pm daily.
offer unique compounding solutions that meet the
For more information, please call us at
866.771.OPPC (6772) or email [email protected]
Or visit us online www.onepointpatientcare.com
Opposition No. 91228995 Kirkland Affidavit Exh. 9
OPPC0000062
Opposition No. 91228995 Kirkland Affidavit Exh. 10
OPPC0000014
Opposition No. 91228995 Kirkland Affidavit Exh. 10
OPPC0000015
Opposition No. 91228995 Kirkland Affidavit Exh. 10
OPPC0000016
When you have chosen an appropriate Horizon Pharma medication
HORIZONCARES HELPS PATIENTS
GET THE MEDICATION THEY NEED
QUICKLY AND AFFORDABLY
TYPICAL RETAIL HORIZONCARES
PHARMACY OUTCOME OUTCOME
PATIENT 31% HORIZONCARES CALLS
PHARMACY
EXPERIENCE
of patients never even go
to the pharmacy1
100%
OF PATIENTS*
OUT-OF-POCKET
COST FOR
29% >99%
do not fill their prescription OF COMMERCIALLY
THE PATIENT due to cost2 INSURED PATIENTS
PAY $10 OR LESS 3
Through HorizonCares,
Horizon Pharma will buy down qualifying
Horizon medication co-pays to $10 or less
for commercially insured patients.
*HorizonCares calls 100% of patients when correct patient contact information is provided.
See Terms and Conditions on reverse side.
References: 1. Partyka G, Plut EM. The patient experiencedelivering 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.
Opposition No. 17,
pdf. Accessed August 91228995
2016. 3. Data onKirkland Affidavit
file. Horizon Pharma Exh. 11
USA, Inc.
OPPC0000065
HOW HORIZONCARES WORKS
Health Care Professional:
EP
1 Prescribes a qualifying Horizon Pharma product
ST
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
EP
2
ST
Patient:
Receives a phone call from Pharmacy within 24
hours
HorizonCares*:
EP
3 Patient pays $0 for prescription, if commercially
ST
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
*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 fill may be $75, but $10 after a mail-in rebate.
©2016 Horizon Pharma USA, Inc.
All rights reserved. December 2016.
Opposition
Printed in the No.
U.S.A. 91228995
P-hc-00024 Kirkland Affidavit Exh. 11
www.horizonpharma.com
OPPC0000066
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 HorizonCares 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.
Opposition No. 91228995 Kirkland Affidavit Exh. 11
OPPC0000067
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.
Opposition No. 91228995 Kirkland Affidavit Exh. 11
OPPC0000068
Your prescription has been sent to a
HorizonCares* participating pharmacy
COMMERCIALLY INSURED PATIENTS PAY
$10 OR LESS
ITS 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
Opposition No.Kirkland
91228995Affidavit Exh. 11
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
*See Terms & Conditions on reverse side.
*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.
Opposition No.Kirkland
91228995Affidavit Exh. 11
©2017 Horizon Pharma USA, Inc. All rights reserved.
January 2017. Printed in the U.S.A. P-hc-00029
www.horizonpharma.com OPPC0000070
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 STAN SNEERINGER
Address PEDERSEN & HOUPT
161 N CLARK STREET , SUITE 2700
CHICAGO, IL 60601
UNITED STATES
Email: [email protected], [email protected],
[email protected]
Submission Testimony For Plaintiff
Filer’s Name Stanley C. Sneeringer
Filer’s email [email protected], [email protected],
[email protected]
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 )
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
COLOR CODE REFERENCE CHART
7am – 10am Pink 8pm – 10pm Gray
11am – 1pm Yellow 11pm – 6am Purple
2pm – 4pm Green PRN Red
5pm – 7pm Orange Controlled Blue
Time Pass Checklist:
1. Refer to Medication Administration Record (MAR)
2. Open the medication cart drawer for the residents 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. ***
ALCCRC.AZ.0208
Opposition No. 91228995 Kirkland Affidavit Exh. 1
OPPC0000039
Opposition No. 91228995 Kirkland Affidavit Exh. 2
OPPC0000029
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
OneConnectPoint is an
of the hospice industry, OneConnectPoint simplifies the admission and invaluable tool. The app
allows me to see what
medication ordering process to reduce the time clinicians spend dealing
has been ordered for any
with pharmacy and ultimately increase the time they have available to patient, saving phone calls to
nurses, the pharmacy and patients.
spend caring for their patients.
Connie, RN
Our simple, seamless and secure technology allows Hospice of the Valley – Arizona
our hospice partners to: Download your FREE
Quickly admit and update patients Create a Prior Authorization for a OneConnectPoint App today
demographics and medication profiles non-formulary medication while placing
Place refill and new medication orders an order
through our integrated e-Rx platform Ability to receive medication profiles
Track the delivery status of a from eMRs Apple, the Apple logo, iPad, are trademarks of Apple Inc.,
medication order Receive Notifications indicating registered in the U.S. and other countries. App Store is a
Verify medication orders real time Prior Authorizations and E-Rx orders service mark of Apple Inc., registered in the U.S. and other
against the hospice formulary, as well pending approval countries.
as screen for drug Interactions
Google Play and the Google Play logo are trademarks of
Google Inc.
For more information, please contact us:
866.771.OPPC (6772) [email protected]
Visit OnePoint Patient Care online:
www.oppc.com
Opposition No. 91228995 Kirkland Affidavit Exh. 3
OPPC0000030
Phone: 866.771.OPPC (6772)
Web: onepointpatientcare.com
ORDER RECEIVED
Your Patient. Your Time.
Instant Prescription Access.
INTRODUCING ONEPOINT PATIENT CARES MOBILE APPLICATION.
Our versatile mobile app delivers an unprecedented level of The Patient Care App is an
invaluable tool. The app
information integration. It streamlines the process so data is allows me to see what has
entered only once for your patients admission, prescription been ordered for any patient,
saving phone calls to nurses,
ordering and clinical management needs. You receive real-time
the pharmacy and patients.
updates to track orders, changes and prescription proile CONNIE, RN
information right from your Windows, Apple, Android device HOSPICE OF THE VALLEY ARIZONA
or your PC.
I can now order medications,
proile orders for future
OUR SIMPLE, SEAMLESS AND SECURE TECHNOLOGY PLATFORMS dispensing and check on
ALLOW YOU TO: order status, all on my
Save time and money with Make informed clinical schedule, from a single,
instant patient information medication decisions integrated app.
access AMY, RN MANAGER
Use OnePointRx to see
Take control of the ordering therapeutic alternative IU HEALTH VNA HOSPICE INDIANA
experience considerations
Know the status of the order Simplify ordering and
in real time proiling information for Download your
new orders and reills, FREE Patient Care
Issue prior authorizations
including controlled Mobile App today at
substances https://mobile.oppc.com
Opposition No. 91228995 Kirkland Affidavit Exh. 3
OPPC0000063
Experience the difference
when patients come first.
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
We understand what is important to you and your patients.
Were a national hospice pharmacy As an integrated pharmacy & PBM,
that owns & controls our own admitting patients and placing
pharmacies utilizing our exclusive medication orders is just one easy
Rx AccuTrack® quality control process. phone call away.
Were employee-owned and report Were technology leaders providing
directly to our hospice partners and and enabling e-Prescribing for
their patients, not shareholders or controlled substances, mobile tools
private equity investors. and real-time data exchange.
Our pharmacists customize preferred Our exclusive reporting system,
drug lists (PDLs) and provide OnePointRx gives you the tools to
formulary/PDL management programs completely align your clinical objectives
speciic to each hospice we serve. with inancial goals and benchmarks.
To learn more, call us at 866.771.OPPC (6772)
Opposition No. 91228995 or email
Kirkland Affidavit Exh. 4 [email protected]
www.onepointpatientcare.com
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
Partnering for Premier Pharmacy Services
XYZ Hospice
Month XX, 2017
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000071
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 1
Agenda
The OnePoint Difference
A Solution That Adds Up
Transition & Account Management
Next Steps
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000072
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 2
The OnePoint Difference
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000073
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 3
4
What Can One Do For You?
Were unique in that were 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 Daily ADC of Over 30,000
providers. Processing Over
200,000 Rxs/month
Nationwide Dispensing
and Delivery Capabilities
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000074
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 4
OnePoints History
1. Founded in 10. In 2015, 11. In 2015,
1965 as began serving introduced
Professional 6. In 2008, Colorado from new logo and
Pharmacy continued our new tagline
national Denver
4. In 2005, 5. Began expansion by
2. Began pharmacy
rebranded as serving Las serving OK,
serving OnePoint Vegas FL, and IL
Arizona Patient Care hospices in hospices
hospices under new
in 1986 2007 as our
ownership first
expansion
market
3. In 1995,
consolidated 12. Today we serve over
into a single 200 programs and
pharmacy, over 30,000
focused on patients/day in 26
hospice states and counting
8. Opened our 9. In 2014,
Vancouver, expanded to
WA pharmacy Detroit, MI
7. Launched
in 2012
Clinical
Consulting
and hospice-
only PBM
capabilities in OPPC OPPC
2008 Locations Serviced
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000075
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 5
OnePoint Proudly Serves Many of
the Nations Leading Hospices
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000076
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 6
Attentive, Flexible & Forward Thinking
T e c hnology
Sc a le
Le a de rship
EM R Ada pt a bilit y
I nt e gra t ion Fle x ibilit y
Cust om iza t ion
Priva t e ly
Ow ne d & Re t e nt ion
Ope ra t e d
Ac t ive Low e r
Ac c ount Cost
M a na ge m e nt Solut ions
Full Suit e
of
Solut ions
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000077
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 7
We Embed and Promote a Superior
Service Culture in All That We Do
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.
Professionalism, personal accountability and integrity are at the core of
Opposition who we are and whatKirkland
No. 91228995 we do, every
Affidavit Exh. hour
5 of every day OPPC0000078
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 8
A Solution That Adds Up
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000079
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 9
OnePoints Solutions Portfolio Creates the
Most Flexible Service Model for Hospice
Supe rior
H ospic e One Point Out c om e s,
I nsight Solut ions Profit a bilit y
& Opt ions
Greater control An adaptive Better patient
in a continually service model outcomes
changing designed to achieved with
environment meet unique profitability &
hospice needs control
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000080
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 10
Hospices Face More Challenges
Than Ever Before H ospic e
I nsight
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
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000081
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 11
Solutions that Allow Hospice to
Choose What They Need One Point
Solut ions
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.
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000082
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 12
Concierge PBM One Point
Solut ions
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
We know
Opposition No. that no
91228995 two hospices areAffidavit
Kirkland the same,
Exh. 5 so we act accordingly
OPPC0000083
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 13
A Custom Preferred Drug List Created with
Your Clinical Team, Managed By OnePoint One Point
Solut ions
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000084
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 14
Next Day Valet: Mail Order One Point
Solut ions
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000085
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 15
Next Day Valet: Mail Order One Point
Solut ions
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)
We create
Opposition a positive,
No. 91228995 memorable service
Kirkland Affidavit experience
Exh. 5 with each call
OPPC0000086
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 16
Direct Express: Local Service One Point
Solut ions
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
A hospice
Opposition pharmacy
No. 91228995 that cares forAffidavit
Kirkland your patients
Exh. 5 as much as you do
OPPC0000087
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 17
Integrated Care Solutions One Point
Solut ions
M obile I nt e grat ion w it h
& De sk t op H ospic e M a na ge m e nt
App Syst e m s
Tailored to Hospice Needs ADT interfaces
Enable CoP Compliance New customer
Puts cost management on-boarding
tools in hospices hands CR8358 Data
Online Reporting
Patient profile
management
Refill orders
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000088
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 18
OneConnectPoint Reporting Provides
Real-Time Access to Patient Data One Point
Solut ions
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
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000089
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 19
OneConnectPoint: Tools & Features One Point
Solut ions
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000090
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 20
CMS CR 8358 One Point
Solut ions
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 has
Opposition No. committed to ADT
91228995 EMR
Kirkland interfacing
Affidavit Exh. 5 with all major vendors
OPPC0000091
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 21
Supe rior
Benefits to Hospice Out c om e s,
Profit a bilit y
& Cont rol
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
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000092
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 22
Transition & Account Management
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000093
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 23
All Solutions Enjoy Active
Transition & Account Management Tra nsit ion
& Ac c ount
M a na ge m e nt
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
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000094
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 24
The OnePoint Difference
One
Ca ll
One
Com pe t it ive One
Adva nt a ge Pa rt ne r
One One
Re sourc e Pric e
One One
Com m it m e nt Le a de r
Opposition No. 91228995 Kirkland Affidavit Exh. 5
OPPC0000095
© 2017 OnePoint Patient Care, LLC. Not to be reproduced, distributed, or transferred in any form except with prior written consent of OnePoint 25
Opposition No. 91228995 Kirkland Affidavit Exh. 6
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
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 nations 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 patients entire drug regimen. OnePoints 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 patients 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.
1
Opposition No. 91228995 Kirkland Affidavit Exh. 7 OPPC0000047
NHM.FAQ.AZ.051209
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, its 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) Im 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?
Its extremely unlikely. If your medication expenses (co-pays and deductibles) are
currently covered under a nationally recognized and commercially available insurance
program, then its 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
2
Opposition No. 91228995 Kirkland Affidavit Exh. 7 OPPC0000048
NHM.FAQ.AZ.051209
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
its difficult to list each one individually. Its 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 its 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?
3
Opposition No. 91228995 Kirkland Affidavit Exh. 7 OPPC0000049
NHM.FAQ.AZ.051209
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. Were not always going to be able to match everyones 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?
Its 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?
Its 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?
4
Opposition No. 91228995 Kirkland Affidavit Exh. 7 OPPC0000050
NHM.FAQ.AZ.051209
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.
5
Opposition No. 91228995 Kirkland Affidavit Exh. 7 OPPC0000051
NHM.FAQ.AZ.051209
OnePoint Patient Care
Explanation of Pharmacy Services
Dear Patient, Family Member or Primary Caregiver:
OnePoint Patient Care is your hospice providers 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 patients 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 Pharmacys 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.
Opposition No. 91228995 Kirkland Affidavit Exh. 7
NHM.OLTP.052209
OPPC0000053
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000031
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000032
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000033
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000034
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000035
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000036
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000037
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
ALAF.AZ.02.08
OPPC0000038
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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: __________________
ALCCAF.AZ.0608
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000041
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
ALNPIF.AZ.0208
OPPC0000043
3006 S. Priest Drive Phone: (480) 240-1111
Tempe, AZ 85282 Fax: (480) 240-1112
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
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000045
NHM.AUTH.AZ.050509
3006 S. Priest Drive Phone: (480) 240-1111
Tempe, AZ 85282 Fax: (480) 240-1112
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: __________________
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000046
NHM.CCAUTH.AZ.031109
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 nations 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 patients entire drug regimen. OnePoints 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 patients 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.
1
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000047
NHM.FAQ.AZ.051209
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, its 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) Im 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?
Its extremely unlikely. If your medication expenses (co-pays and deductibles) are
currently covered under a nationally recognized and commercially available insurance
program, then its 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
2
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000048
NHM.FAQ.AZ.051209
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
its difficult to list each one individually. Its 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 its 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?
3
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000049
NHM.FAQ.AZ.051209
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. Were not always going to be able to match everyones 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?
Its 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?
Its 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?
4
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000050
NHM.FAQ.AZ.051209
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000031
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000032
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000033
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000034
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000035
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000036
3006 S. Priest Dr.
Tempe, AZ 85282
Phone: (480) 240-1122
Fax: (480) 240-1123
Email: [email protected]
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000037
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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)
Opposition No. 91228995 Kirkland Affidavit Exh. 8
ALAF.AZ.02.08
OPPC0000038
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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: __________________
ALCCAF.AZ.0608
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000040
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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: __________________
ALCCAF.AZ.0608
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000041
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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 ***
Opposition No. 91228995 Kirkland Affidavit Exh. 8
ALNPIF.AZ.0208
OPPC0000043
3006 S. Priest Drive Phone: (480) 240-1111
Tempe, AZ 85282 Fax: (480) 240-1112
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
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000045
NHM.AUTH.AZ.050509
3006 S. Priest Drive Phone: (480) 240-1111
Tempe, AZ 85282 Fax: (480) 240-1112
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: __________________
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000046
NHM.CCAUTH.AZ.031109
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 nations 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 patients entire drug regimen. OnePoints 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 patients 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.
1
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000047
NHM.FAQ.AZ.051209
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, its 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) Im 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?
Its extremely unlikely. If your medication expenses (co-pays and deductibles) are
currently covered under a nationally recognized and commercially available insurance
program, then its 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
2
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000048
NHM.FAQ.AZ.051209
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
its difficult to list each one individually. Its 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 its 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?
3
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000049
NHM.FAQ.AZ.051209
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. Were not always going to be able to match everyones 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?
Its 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?
Its 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?
4
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000050
NHM.FAQ.AZ.051209
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.
5
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000051
NHM.FAQ.AZ.051209
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 patients 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 Pharmacys 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 patients 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 patients third party
insurance will NOT be processed at OnePoint Patient Care without prior authorization. We will contact the
patients physician for a prior authorization. If we are unable to get the prior authorization, we will contact
you for the patients 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
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000052
OnePoint Patient Care
Explanation of Pharmacy Services
Dear Patient, Family Member or Primary Caregiver:
OnePoint Patient Care is your hospice providers 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 patients 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 Pharmacys 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.
Opposition No. 91228995 Kirkland Affidavit Exh. 8
NHM.OLTP.052209
OPPC0000053
3006 S. Priest Drive Phone: (480) 240-1122
Tempe, AZ 85282 Fax: (480) 240-1123
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 physicians 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.
1
Opposition
ALNOPP..AZ.0208
No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000054
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 persons
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 persons 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: ___________
2
Opposition No. 91228995 Kirkland Affidavit Exh. 8 OPPC0000055
ALNOPP..AZ.0208
ONEPOINT PATIENT CARES
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 OnePoints
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. OnePoints 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
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000056
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
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000057
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
Opposition No. 91228995 Kirkland Affidavit Exh. 8
OPPC0000058
The only national hospice pharmacy
capable of providing local deliveries to
your patients daily within hours!
Custom-designed dispensing
and delivery models including
OnePoint Local Pharmacy and
Mail Order Pharmacy services
Transparent, cost-plus
Pharmacy Beneits Manageme
(PBM) services for national,
multi-regional and stand-alon
hospices
25 years of clinical expertise
Hospice management integrat
E-prescribing capabilities via
our Patient Care App
Were 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.
To learn more please call us
at 866.771.OPPC (6772)
or email
Opposition No. 91228995 Kirkland Affidavit 9 @ oppc.com
Exh. sales
www.onepointpatientcare.com
OPPC0000001
Phone: 866.771.OPPC (6772)
Web: www.onepointpatientcare.com
OnePoint Patient Care is the nations 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.
Were 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 Clinical Consulting Clinical Management Local Hospice Delivery Direct to
Pharmacy and Drug Screening Solutions Pharmacy Center of Home
(PBM/PBA) Excellence
A DEDICATED HOSPICE PHARMACY CLINICAL CONSULTING AND DRUG SCREENING
Our superior service model is founded on the Our experienced clinical professionals offer
simple principle that outstanding patient care can best detailed, immediate therapeutic consulting with
be achieved when hospice pharmacy specialists screen every call. We offer hospices the unique ability to
and dispense medications locally and deliveries are screen each patients drug therapy based on terminal
made in a timely manner direct to patient sites by our diagnosis, and we screen for duplicate therapies. We
own captive delivery personnel. As a dedicated hospice offer hospices complete compliance with the latest
pharmacy, were willing and capable of customizing hospice COPs (Conditions of Participation) related to
a formulary for each hospice program we serve. the initial and comprehensive assessment of the patient
We believe that every hospice has unique clinical as well as the entire patient drug therapy. We offer
and inancial needs; therefore, hospices should utilize a robust library of in-service education programs for
their own unique formulary allowing them to achieve hospice team members and our clinical experts are
their individual objectives. Our clinical professionals happy to participate in hospice IDG (Inter-Disciplinary
have the experience and knowledge required to assist Group) meetings and offer CQI (Continuous Quality
you in the creation of a distinct formulary designed Improvement) team support.
exclusively for your patients and hospice program.
The Hospice Pharmacy Services Provider
CLINICAL MANAGEMENT SOLUTIONS (PBM/PBA) We also offer Patient Care Kits for a patients home
We offer medication management programs as well as narcotic and non-narcotic boxes for
designed to provide superior, yet cost-effective, end- inpatient unit staff providing immediate access in
of-life care. Our clinicians provide comprehensive cost- times of emergencies.
containment measures and hospice-speciic formulary
We are proud experts in drug compounding. We
management programs customized for each partner
offer unique compounding solutions that meet the
we serve. We eliminate and/or minimize drug orders
individual needs of each hospice patient we serve.
not related to terminal diagnosis. We offer therapeutic
Drug compounding is the customization of a drug
interchange options that provide additional cost savings
requested by a physician that requires a speciic
and eliminate duplicate therapies. We also provide
dosage or form not currently commercially available.
hospices with 24-hour access to our industry-leading
Our compounding is performed by clinical experts and
reporting tools. OnePointRx is our internally designed,
is customized according to a patients speciic need.
password-protected reporting suite providing hospices
Many hospice programs and patients realize there
with unlimited access to a full-range of customized
are a limited number of strengths and dosage forms
administrative, inancial and clinical reports, including
commercially available for hospice care. Some
a comprehensive Plan of Treatment (PoT) Report for
commercially manufactured medications may not meet
every patient we serve. OnePointRx is available on
the precise needs of many hospice patients; therefore,
any web-enabled PC, laptop, iPad, iPhone, Android or
the interest for hospice compounding has increased
Blackberry mobile device.
dramatically in providing superior end-of-life care.
LOCAL HOSPICE PHARMACY CENTER OF EXCELLENCE
DELIVERY Customer Care Specialists
Serving hospice programs for over 25 years,
We refer to our delivery personnel as Customer
OnePoint Patient Care has developed systems and
Care Specialists because they deliver exceptional service
capabilities customized to the unique needs of hospice.
to our hospice patients and their families. We employ
We recruit, hire and retain the nations leading and manage a local captive delivery organization
pharmacy professionals who specialize in hospice care specializing in prescription delivery. Each employed
and distinguish themselves with their knowledge of delivery representative is uniformed, identiiable with
hospice medication, dosage conversions, interactions a name badge and is subject to a comprehensive
and drug-to-drug interactions. As part of our standard background check, dress code and grooming policies.
dispensing service we screen for the most clinically
appropriate and cost-effective alternative therapies. DIRECT TO HOME
Hospice care teams always have direct pharmacy Our Customer Care Specialists proudly deliver
contact with each call and we are properly staffed hospice medications direct to each patients site 24
to exceed your service expectations. Our team is hours a day, 365 days a year, regardless of patient
available to provide 24-hour clinical advice, support setting, including but not limited to the patients private
and therapeutic recommendations. home, long-term care facility or in-patient unit
(IPU). We always call to verify all orders delivered after
It is important to us that we are able to provide you
8pm daily.
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
For more information, please call us at
orders are processed and delivered within two hours
866.771.OPPC (6772) or email [email protected]
from a well-stocked local inventory of your custom
formulary medications. Or visit us online www.onepointpatientcare.com
Phone: 866.771.OPPC (6772)
Web: www.onepointpatientcare.com
OnePoint Patient Care is the nations leader in providing total hospice pharmacy services.
We provide daily in-home deliveries from our local pharmacies in each market we serve.
Were 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 patients home, long-term-care facility or inpatient unit.
$
A Dedicated Clinical Cost Dispensing Delivery Direct to
Hospice Consulting Management Home
Pharmacy (PBM / PBA)
A Dedicated Hospice Pharmacy as well as the entire patient drug therapy. We offer
Our superior service model is founded on the a robust library of in-service education programs for
simple principle that outstanding patient care can best hospice team members and our clinical experts are
be achieved when hospice pharmacy specialists screen happy to participate in hospice IDG (Inter-Disciplinary
and dispense medications locally and deliveries are made Group) meetings and offer CQI (Continuous Quality
directly to patient sites by our own captive delivery Improvement) team support.
personnel. We provide partners with both covered and
non-covered medications (for hospice partners that Cost Management (PBM/PBA)
$
qualify) for their hospice patients and we customize our We offer medication management programs
service in ways that other pharmacies do not. designed to provide superior, yet cost-effective,
palliative care. Our clinicians provide comprehensive cost
Clinical Consulting and Drug Screening containment measures and hospice-speciic formulary
Our experienced clinical professionals offer management programs customized for each partner
detailed, immediate therapeutic consulting with we serve. We eliminate and/or minimize drug orders
every call. We offer hospices the unique ability to not related to terminal diagnosis. We offer therapeutic
screen each patients drug therapy based on terminal interchange options that provide additional cost savings
diagnosis, and we screen for duplicate therapies. We and eliminate duplicate therapies.
offer hospices complete compliance with the latest
hospice COPs (Conditions of Participation) related to
the initial and comprehensive assessment of the patient
Opposition No. 91228995 Kirkland Affidavit Exh. 9
OPPC0000061
The Hospice Pharmacy Services Provider
Dispensing & Custom Compounding individual needs of each hospice patient we serve. Drug
Serving the hospice market for over 20 years, compounding is the customization of a drug requested by
OnePoint Patient Care has developed systems and a physician that requires a speciic drug dosage or form
capabilities customized to the unique needs of our not currently commercially available. Our compounding
hospice partners. is performed by clinical experts and is customized
according to a patients speciic need. Many hospice
We recruit, hire and retain the nations leading
programs and patients realize there are a limited number
pharmacy professionals who specialize in hospice care
of strengths and dosage forms commercially available
and distinguish themselves with their knowledge of
for hospice care. Some commercially manufactured
hospice medication, dosage conversions, interactions and
medications may not meet the precise needs of many
alternative therapies. As part of our standard dispensing
hospice patients; therefore, the interest for hospice
service, we screen for drug-to-drug interactions. Hospice
compounding has increased dramatically in providing
care teams always have direct pharmacy contact with
superior palliative care.
each call and are never placed into an electronic queue
waiting to speak with a pharmacy representative. Our
Delivery Our Customer Care Specialists
team is available to provide 24-hour clinical advice,
We refer to our delivery personnel as Customer
support, and therapeutic recommendations.
Care Specialists because they deliver exceptional
It is important to us that we are able to provide you with service to our hospice patients and their families. We
the information you want at the time of the order. To employ and manage a local captive delivery organization
this end, each staff member has a computer terminal, specializing in prescription delivery. Each employed
full patient proile and drug history at their ingertips delivery representative is uniformed, identiiable
when you call. with a name badge and is subject to a comprehensive
background check, dress code and grooming policies.
In addition, when a patient is in need of immediate
medication, we offer STAT service that will get the order
Direct To Home
processed and delivered within two hours.
Our Customer Care Specialists proudly deliver
We also offer customized Patient Care Kits for a hospice medications direct to each patients site 24
patients home as well as narcotic and non-narcotic hours a day, 365 days a year, regardless of patient
boxes for inpatient unit staff providing immediate setting, including but not limited to the patients private
access in times of emergencies. homes, long-term-care facility and in-patient units
(IPUs). We always call to verify all orders delivered
We are proud experts in drug compounding. We
after 8pm daily.
offer unique compounding solutions that meet the
For more information, please call us at
866.771.OPPC (6772) or email [email protected]
Or visit us online www.onepointpatientcare.com
Opposition No. 91228995 Kirkland Affidavit Exh. 9
OPPC0000062
Opposition No. 91228995 Kirkland Affidavit Exh. 10
OPPC0000014
Opposition No. 91228995 Kirkland Affidavit Exh. 10
OPPC0000015
Opposition No. 91228995 Kirkland Affidavit Exh. 10
OPPC0000016
When you have chosen an appropriate Horizon Pharma medication
HORIZONCARES HELPS PATIENTS
GET THE MEDICATION THEY NEED
QUICKLY AND AFFORDABLY
TYPICAL RETAIL HORIZONCARES
PHARMACY OUTCOME OUTCOME
PATIENT 31% HORIZONCARES CALLS
PHARMACY
EXPERIENCE
of patients never even go
to the pharmacy1
100%
OF PATIENTS*
OUT-OF-POCKET
COST FOR
29% >99%
do not fill their prescription OF COMMERCIALLY
THE PATIENT due to cost2 INSURED PATIENTS
PAY $10 OR LESS 3
Through HorizonCares,
Horizon Pharma will buy down qualifying
Horizon medication co-pays to $10 or less
for commercially insured patients.
*HorizonCares calls 100% of patients when correct patient contact information is provided.
See Terms and Conditions on reverse side.
References: 1. Partyka G, Plut EM. The patient experiencedelivering 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.
Opposition No. 17,
pdf. Accessed August 91228995
2016. 3. Data onKirkland Affidavit
file. Horizon Pharma Exh. 11
USA, Inc.
OPPC0000065
HOW HORIZONCARES WORKS
Health Care Professional:
EP
1 Prescribes a qualifying Horizon Pharma product
ST
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
EP
2
ST
Patient:
Receives a phone call from Pharmacy within 24
hours
HorizonCares*:
EP
3 Patient pays $0 for prescription, if commercially
ST
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
*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 fill may be $75, but $10 after a mail-in rebate.
©2016 Horizon Pharma USA, Inc.
All rights reserved. December 2016.
Opposition
Printed in the No.
U.S.A. 91228995
P-hc-00024 Kirkland Affidavit Exh. 11
www.horizonpharma.com
OPPC0000066
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 HorizonCares 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.
Opposition No. 91228995 Kirkland Affidavit Exh. 11
OPPC0000067
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.
Opposition No. 91228995 Kirkland Affidavit Exh. 11
OPPC0000068
Your prescription has been sent to a
HorizonCares* participating pharmacy
COMMERCIALLY INSURED PATIENTS PAY
$10 OR LESS
ITS 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
Opposition No.Kirkland
91228995Affidavit Exh. 11
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
*See Terms & Conditions on reverse side.
*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.
Opposition No.Kirkland
91228995Affidavit Exh. 11
©2017 Horizon Pharma USA, Inc. All rights reserved.
January 2017. Printed in the U.S.A. P-hc-00029
www.horizonpharma.com OPPC0000070