This article provides guidance for support agents on handling inquiries from members who have been discharged from prescribing services and provided a clinical override to continue their medication with an external prescriber.
Understanding the Override Status
When a member is discharged from Vida's prescribing services and transitioned to an external provider for their GLP-1 medication, the Clinical Operations team may submit a clinical override. This allows the member to continue using their medication with a new prescriber.
The key message to convey to the member (as suggested by Clinical Operations) is:
"Members who present for clinical review or are referred by their VMP for management of their GLP-1 prescription outside of Vida may be eligible for a clinical override. Clinical overrides are submitted by the Clinical Operations team and PSG can process, verify, or troubleshoot for a member who reports they have a clinical override."
What Agents May See (Admin/Tickets)
There is no direct indicator of an override status within the Admin system. This process is currently tracked manually by the Clinical Operations team.
What Agents May See (Admin/Tickets)
| Indicator | Details and Interpretation |
|---|---|
| Admin System | Go to Programs > Program Instances and check the status of AMS. Click the AMS link to review the chat history for discharge notes. Note: There is still no direct indicator of an override status here; the status is tracked manually by Clinical Operations. |
| AMS Program | The member's AMS Program may be marked as "Complete." This often aligns with a clinical discharge and transition to an external prescriber. |
| Ticket Notes/Chat | The discharge and transition will typically be first indicated in the ticket notes, chat history, or a clinical note once the initial review/escalation has occurred. |
| Member Inquiry | The member may explicitly state they were told they have a "clinical override" or that they are now using an "external prescriber." |
Escalation Process for Override Inquiries
If a member contacts support with an issue specifically related to a clinical override (e.g., their pharmacy cannot process the prescription, they need confirmation of the override, or they are having troubleshooting issues), the process is as follows:
- Acknowledge and Use Approved Verbiage: Use the approved language above to confirm their eligibility for the override.
- Escalate Immediately: Since the status is tracked manually and requires specialized troubleshooting, immediately escalate the ticket.
- Assignment: Auto-assign the ticket directly to PSG Tier 3.
🛑 Escalation Rule: For any issue related to a clinical override, auto-assign to PSG Tier 3 for resolution.
Timeframe Guidance
The review and verification process for overrides varies by Pharmacy Benefit Manager (PBM) and account. Due to this variability, do not provide a specific timeframe to the member. Advise the member that the team is working on their request and will update them as soon as the override status is confirmed or processed.
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