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Start-to-First-Fill
PAMS Access Toolkit
Reference · no patient data

Day 0 is the day the prescription was written. Enter the day each milestone actually happened; the track shows where you are against target.

Tracking real patients? The practice tracker keeps every biologic patient in one list, with stall alerts and a practice dashboard. Patient details stay in the browser on your clinic computer — they never reach Dermsquared.
0/10
milestones passed
0
days since prescription
0
overall — days behind target, running total
0
this step — days over its own budget
d01Prescription writtend22PA submittedd73PA approved/ deniedd94Specialty pharmacyidentifiedd125Copay determinedd166Assistance identifiedd197Prescription scheduledd218Shippedd239Deliveredd2510Started
leg on budget leg slipped● node color = overall position not reached┃ today▽ target day

Cumulative variance

running total of days behind target — the number a single step can hide
0DAYS BEHIND ↑ahead ↓

Milestones

“Approval is not access.” — Improving the Patient Journey §17
1
Prescription written
provider
day 0
——
2
PA submitted
bc
Complete beats fast — but submit the same week. §15.
day 2
——
3
PA approved / denied
payer
A denial here branches into the T2 ladder. Read the denial before you appeal (§20).
day 7
——
4
Specialty pharmacy identified
bc
Check the plan's mandated pharmacy against the Rx card BIN/PCN, not your usual one.
day 9
——
5
Copay determined
pharmacy
Approval is not affordability. Get the actual dollar figure. §17
day 12
——
6
Assistance identified
bc
Confirm the hub has the approval or denial — a hub cannot act on information it cannot see. §19
day 16
——
7
Prescription scheduledpharmacy may not report
pharmacy
The pharmacy must speak to the patient. Warn them it will be an unknown number.
day 19
——
8
Shippedpharmacy may not report
pharmacy
day 21
——
9
Deliveredpharmacy may not report
pharmacy
Delivered is not started. Confirm the patient has it and knows what to do.
day 23
——
10
Startedpharmacy may not report
patient
The only milestone that counts as done. §25
day 25
——
Lab gateSkyrizi requires a TB test before therapy begins. If it is not on file, milestone 3 will stall regardless of the PA outcome.
ScheduleStarter: 150 mg SC at week 0 and week 4, then every 12 weeks. Day supply 1 per 28 days. Maintenance: 150 mg SC every 12 weeks.

Team handoff

START-TO-FIRST-FILL HANDOFF
Skyrizi · Psoriasis · commercial
Day 0 since prescription written · 0/10 milestones
Overall: on target · this step: within budget

[ ] 1. Prescription written — provider — target day 0
[ ] 2. PA submitted — bc — target day 2
[ ] 3. PA approved / denied — payer — target day 7
[ ] 4. Specialty pharmacy identified — bc — target day 9
[ ] 5. Copay determined — pharmacy — target day 12
[ ] 6. Assistance identified — bc — target day 16
[ ] 7. Prescription scheduled — pharmacy — target day 19
[ ] 8. Shipped — pharmacy — target day 21
[ ] 9. Delivered — pharmacy — target day 23
[ ] 10. Started — patient — target day 25

NEXT: Prescription written (provider)

No patient identifiers recorded in this tool.

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