Blue
Those who reveal information prior to what date, will be subject to disciplinary actions?
A. Oct 15
B. Oct 1
C. Sept 1
D. Sept 30
B. Oct 1
Members can get their GLp-1 medications through?
A. Enguide
B. Express Script
C. CVS retail home delivery
D. Preferred Pharmacy
A. Enguide
Agents should ___ calculate coinsurance based on the 'cost of medications' or deductible amount.
A. Only
B. Not
C. When asked
D. When approved
B. Not
Oct 15- Dec 31 we should inform members of which tool?
A. Wellcare Website
B. Formulary Search Tool
C. Ascend
D. Anoc letters
B. Formulary Search Tool
Members must submit an appeal within ___calendar days from the date of the coverage determination denial notice.
A. 60
B. 90
C. 30
D. 65
D. 65
If member is taking a non formulary PCD or is exceeding the quantity limit on a PCD, they will be afforded a __ supply via the part D TOC.
A. 90 days
B. 60 Days
C. 7 days
D. 30 days
D. 30 days
___ includes copays, coinsurance, and deductibles.
A. Troop
B. OOP
C. Cost of share
D. Cost Share
D. Cost Share
How many drugs were negotiated for 2026?
A. 5
B. 6
C. 9
D. 10
D. 10
For PCD the system will auto approve a claim if there has been a paid claim for the same drug in __ _days.
A. 90
B. 60
C. 180
D. 120
C. 180
Members may receive their updates for next year between what dates?
A. Sept 1 – Sept 30
B. Oct 1 - Oct 30
C. Oct 15 - Oct 30
D. Dec 1- Dec 31
A. Sept 1 – Sept 30
If member was enrolled by ____, members may be able to cancel plan based on date in OEV letter.
A. Wellcare
B. Family Member
C. Assisted Enrollment
D. CMS
C. Assisted Enrollment
If Pharmacy does not say extended days supply members can only get less than a 90 days supply. T/F
False
Drugs that prevent the body from rejecting transplanted organs or treat certain autoimmune diseases are called what?
A. Immunosuppressant
B. Antineoplastic
C. Anticonvulsant
D. Antidepressant
A. Immunosuppressant
___ helps to pay for in-patient hospital stays, skilled nursing facility care after a hospital stay, hospice care and certain home health services.
A. Outpatient Insurance
B. Wellcare
C. Part A
D. CMs
C. Part A
The member will always pay the ____ amount, so if the medication cost is less than the copay amount, the member will pay which amount.
A. Co pay
B. Coinsurance
C. Lesser
D. Deductible
C. Lesser
Members can request a Tier Exception on or after ___.
A. 09/30/2026
B. 10/01/2026
C. 11/28/2026
D. 01/01/2026
D. 01/01/2026
Members with what kind of plan may meet their OOP max before paying $2100?
A. Value Plus
B. Value Script
C. Classic
D. Enhanced
D. Enhanced
Paper application takes how long to be verified?
A. 10 days
B. 7 days
C. 24-48 hours
D. 10 business days
D. 10 business days
What plan will value plus members be moving to 1/1/2026?
A. Value Plus
B. Value Script
C. Classic
D. It is being discontinued
B. Value Script
Medicare Part D is for people with Medicare Part A and/or Part D benefits. T/F
False
What will be the co pay for tier 1 medications in the ICL stage at a preferred pharmacy ?
A. $5
B. $3
c. $15
D. $0
D. $0
Some members may have no _ for certain drug tiers.
A. Co pay
B. Deductible
C. LIS
D. Cost
B. Deductible
How many tiers will the Value Script plan have for 2026?
A. 6
B. 0
C. 5
D. It is being discontinued
A. 6
if member has __ with enrollment source C do not submit disenrollment request
A. Another plan
B. Auto assignment
C. Insurance through their job
D. Enhanced plans
C. Insurance through their job
What is the OOP threshold for members for 2026?
A. $2000
B. $615
C. $2150
D. $2100
D. $2100