Medicine
These medications include ointments, creams, gels, certain types of inhalers and pastes. Except for _____ inhalers, the rest are used almost exclusively as topical treatments.
Semi-Solids
_______ is anyone in the medical profession licensed to prescribe medication. The most common of these include medical doctors, nurse practitioners, dentists, and mental health providers
A prescriber
______ agrees to fill prescriptions for our plan members at a negotiated preferred or standard rate. Members may receive their drugs at a lower cost to the member in the form of a copay or coinsurance percentage when using these pharmacies.
A participating pharmacy
View communications from the ________ window on the member's CRM Person Account or Plan Member page. If the communication is not found in CRM, access the communication in EMME.
RTI Communication / RTI
_____ may sponsor Patient Assistance Programs (PAP) that provide financial assistance or drug free products through in-kind donations to help low-income individuals who cannot afford their prescription medications.
Pharmaceutical manufacturers
_________ common in the retail setting are vials and pre-filled syringes. Hospitals and pharmacies that dispense to care facilities utilize a third type called a cartridge or ampule; a sealed glass capsule containing a liquid.
Injectable medications
______ is responsible for protecting and promoting public health through the control and supervision of food safety, tobacco products, prescription and over-the-counter pharmaceutical drugs
The FDA
Most national retail chain stores are contracted with Humana. ___________ tool contains a listing of network pharmacies available nationwide.
The Pharmacy Finder
_______ allow members to better forecast and budget their prescription spending accordingly. These also provide overviews of medications to help manage taking and refilling medications more effectively.
SmartSummaries
Members may be eligible for additional financial assistance through a _______. These are state-sponsored programs designed to assist low-income individuals with premium, deductible, and/or copayment subsidies to qualified Medicare members.
State Pharmaceutical Assistance Program (SPAP)
Most prescriptions are manufactured in specific strengths for each form which make up the actual dose. Dosing forms like lotions and creams are considered non-countable items because of the difficulty specifying how much to apply and appropriate length of use.
Non-Countable Items
Medications used with Durable Medical Equipment (DME) or received from a:
Medical (Part B) Covered
What is the Classification and Intent for locating pharmacies?
Maximize Your Benefit (MYB) letters encourage members taking high-cost medications to discuss switching to a lower-cost alternative with their doctor. The letter includes up to three lower-cost generic and over-the-counter options, if available, for each target drug, a member has taken in the past ______.
90 days
Individuals qualified as low income may qualify for financial assistance through a federal government program. The subsidy program called ______ offers extra help for those needing financial assistance with their prescription premium, deductible, and/or copayments.
Extra Help/ Low Income Subsidy
Branded drugs are way pricier because, drug companies who have manufactured them, have obtained a drug patent. Meaning, that no one else in the market can produce or manufacture the drug until the patent expires, which usually lasts between _________ years.
17 to 20 years
When a generic drug is available, pharmacists typically dispense the generic form unless the prescription specifically indicates otherwise.
Dispense as Written
For Mail Order Pharmacy: ________ fill specialty drugs.
CenterWell Specialty Pharmacy
Members receive their _______ through mail or electronically depending on their communication preferences. This helps inform members of the action they would like to take during AEP (i.e., keep their plan, disenroll, or change plans).
Annual Notification of Change (ANOC)
_____ members have both Medicare and Medicaid coverage. Members with the this icon visible in CRM are assisted by advocates trained to support dual eligible members
Dual eligible
What tier is the Specialty Drug?
Tier 5
For example, a person may be prescribed a medication to take two tablets per day, or 60 tablets per month. If the medication has a _______ of 30 tablets per month, the member's doctor will need to work with HCPR to get prior authorization for a higher quantity.
Quantity Limit
_________ work through health insurance providers to deliver medications straight to your home. These service makes it much easier for people who can’t or don’t want to stop at their local drugstore to get the medications they need.
Mail order pharmacies
What is the Classification and Intent for calls regarding SmartSummary
Members taking eight or more medications may qualify for the ______ program.
Medication Therapy Management (MTM)