Corporate Pharmacy
Formularies
Tier Definitions
ACA Individual
100
Rx Deductibles are separate from______________deductibles.
What is MEDICAL
100
1. What is the date for the new drug list change?
What is 01/01/2017
100
The prescription drug tier which consists of the lowest cost tier of prescriptions drugs, most are generic
What is TIER 1
100
American Indian and Alaskan native plans are on__________.
What is MAC C PRICING
200
Our ACA plans have integrated medical and pharmacy benefits. Which means all benefits apply to the¬¬¬______________________.
What is TRUE OUT OF POCKET
200
4. How many appear tiers does the Enhanced formulary have?
What is 5
200
The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty drugs.
What is TIER 5
200
Members should verify any restrictions that apply or authorizations required using our__________
What is PHARMACY UM PAGE
300
The normal turnaround time for Step Therapy reviews is _______
What is 24 HOURS
300
3. What may appear on many different formularies?
What is GROUP POLICIES
300
The prescripton drug tier which consists of the highest-cost prescription drugs, most are specialty drugs.
What is TIER 4
300
MAC Pricing – effective 1/1/12016 all individual ACA Plans changes from MAC B to ________
What is MAC A PRICING
400
If there is an ______ hold code, then the Medical deductible does NOT apply first.
What is NH
400
5. What website can you find more information on BCBS prescription medication formularies?
What is BCBSNC.COM
400
The prescription drug tier which consists of medium-cost prescription drugs, most are generic, and some brand-name prescription drugs.
What is TIER 2
400
2) The Basic Open Formulary can be searched
What is WWW.MYPRIME.COM
500
The ____________ screen shows details of the pharmacy claim and the Member responsibility
What is CLAIM TRANSACTION DETAIL
500
2. What two Groups will use Commercial Formularies if the metallic plan is not purchased?
What are FULLY INSURED & ASO GROUPS
500
The prescription drug tier which consists of higher-cost prescription drugs, most are brand-name prescription drugs, and some are specialty drugs.
What is TIER 3
500
If a member purchase a brand name prescription when a generic drug is available, members will be charged their brand co-pay or coinsurance amount plus the difference in cost between the brand and generic drug, if there is a generic on the market. Name the exception to the rule:
What is if a member has a medical reaction to a generic drug, there will be no penalty affix to the member.
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