True or False?
True or False? A member can mail in a physical prescription to express scripts
True.
extra points for where to find the address in csp
Plan Design that gives members the OPTION to fill meds at a 90 day supply with ES or a pharmacy in network, but there is no penalty if they choose not to.
90VOL
Member wants to know common uses for atorvastatin.
PCT
Member wants to put an existing med on auto fill.
In Scope: prescription list> mail pharmacy
All medications are showing 'NOT COVERED" on member's account
Search for alternate accounts that may have coverage
True or False: If a medication price says "unavailable" in drug coverage it means we do not have it in stock
False. Drug availability will never show up in dcdp
Plan Design that REQUIRES members to fill a 90 day supply through HD OR a pharmacy in network.
90EX/ 90IC
Member wants to know which med is for their blood pressure.
RPH
Member wants to take a med off Auto Fill
In Scope: Prescription list> Mail pharmacy
You are unable to find the medication in drug coverage that the member is requesting
Ask Rph
True or False? When verifying doctor on file, you must say the doctor's full name and full address OR name and phone number.
True.
Plan design that requires a choice on file in HAP
SHD-AC
If a member INSISTS that we transfer a rx from US to a local pharmacy and their pharmacy will not call us.
RTL Escalation. (Do not proactively offer)
Member wants to cancel a prescription because they are no longer taking it.
Out of Scope: CS
Member asks if their medication requires a Prior Authorization
Check Drug Coverage and see if coverage review (PA) is required. If so, give then the number listed in DC.
True or False: If a plan requires a choice on file, you only have to place it if they want to remain at retail pharmacy
False. If no choice is currently on file, it must be placed on file regardless of where the member decides to fill.
Plan Design that requires a choice on file in Patient Preferences
90AC
Member wants to know if we have their medication in stock.
CS
Member wants to add a caregiver, (personal representative) to their account
In Scope
Profile> caregiver> send email
Doctor does not have a secure fax number listed on HD Opp screen OR on RX Request
MDO Template
True or False? You can speak to a caregiver on file about everything as if they were the member.
True
Plan Design that requires members to fill long term meds through HD to avoid price increase or possible reject in coverage.
EHD (Exclusive Home Delivery)
Member says they had to stop medication because it gave them a bad/ allergic reaction.
Mandatory RPH transfer.
Member wants status update on a med that says Cancelled on order status screen.
Out of Scope: CS (unless contact center trained)
A retail pharmacy calls for a rx transfer
Transfer to RPH patient consult
(after authenticating account, getting the callers name, pharmacy name, call back number and name of med they would like to transfer )