The Pill Drill
Orally, nasally, topically and injectable are all types of _____________ methods.
Administration
A flu shot at the Doctors office would be covered under this part of a member's plan.
Part D
Deductible, Initial Coverage and Catastrophic Coverage are all examples of pharmacy _____________
Benefits Stages
This system allows physicians to check if a medication requires a preauthorization, request a coverage determination form, check the status of a prior authorization review and check to see if a less restrictive alternative medication exists.
Humana's Interactive Voice Response system
The name, dosage and frequency are entered in this system to verify if a medication is covered and the members copay.
RxConnect Pro
DMR claims can be filed electronically through this system.
PromptPa
This rapper made headlines for performing nearly nude at the 2023 MTV VMAs.
Doja Cat
These are taken on a regular basis over an extended period of time to treat an ongoing medical condition.
Maintenance Medications
For a non-controlled prescription refill a member must use how much of their previous prescription before a new refill is available.
75%
A member must pay this amount out of pocket to reach the Catastrophic Stage.
$2000
Members will receive this type of call within 72 hours of an authorization being approved.
VAT (Voice Automated Technology)
You can find what stage a member is in under this section of RxConnect Pro.
Stage Tracker
A COB overide can only be valid for this many days.
30
He slapped Chris Rock on live TV at the 2022 Oscars.
Will Smith
An authorization that requires lesser expensive formulary medications to be tried first before an approval can be made.
Step Therapy
Hospitals, Home Health Care Agencies, Rehabilitation Centers and Long Term Care Facilities can all provide these medications.
Part B Drugs
Member will pay full cost for covered medications during this stage of their benefits.
Deductible
Authorization and Referrals are located on this CRM page.
Plan page/Umbrella page
If a medication shows Covered With Restrictions, what do we need to request for them.
prior authorization
Mail order overrides are only valid for ____ days
5
This comedian hosted the show “The Man Show” in the early 2000s.
Jimmy Kimmel
Experimental drugs, repackaged drugs, foreign drugs are all examples of what.
Non-Covered Medications
If a doctor requires a prescription be filled with a brand name drug they will use this DAW code.
1-Physician indicates dispense as written
True Out of Pocket accumulator shows us how much is paid by whom?
Member
An expedited authorization request is completed within this time frame.
within 24 hours of documentation receipt
If a member receives a letter telling them their medication will not be covered in their new plan year. What can be requested for them.
Drug Formulary exception
A hard error will cause a pharmacy claim to _____
deny
This singer turned actor starred in Don’t Worry Darling and had a high-profile romance with director Olivia Wilde.
Harry Styles
All medications covered under a members plan can be found on their.
Drug Formulary
BIN and PCN Numbers can be found where
On the front of the members insurance card and Mentor
Prescription payments made by family and friends, Indian Health Service, AIDS drug assistance programs, Extra Help program, State Pharmaceutical Assistance programs (SPAP) and most charities are all eligible to be included in the members ___________
TROOP (True Out of Pocket)
This outcome status indicates that the information from the physician was not received.
EOC Aborted
If a member states that they cannot afford a tier 2 or 3 medication, what can be requested for them.
Tier exception
PAC, PWE and CAC are all examples of this
paid claim
He made headlines in 2023 for wearing a sheer mesh tank top at the Met Gala.
Bad Bunny
Short fill, asking for samples, using coupons, filing a claim with homeowner's insurance or calling 211 are all things a member can do for this situation.
Drug not covered
A 10 digit number used to identify the Manufacturer, Medication name and Package Code
NDC - National Drug Code
New for 2025 this stage is no longer in effect but this stage required member to pay 25% of their drug costs and many members still fear it.
Coverage Gap/Donut Hole
When a member requests to expedite the prior authorization review we transfer to this department.
HCPR (Humana Clinical Pharmacy Review)
A 30 day transition supply of a medication is only available when?
within the first 90 days of their eligibility
Rx Nova error codes 082, 147 and 300 would require a member to get what
prior authorization
This controversial adult-themed animated series, originally on Comedy Central, features raunchy humor and talking food.
Drawn Together