Pharmacy
How many stages are there in prescriptions drugs?
3 (deductible, initial coverage, catastrophic)
What are some different programs we can offer member's who need help paying for medications?
Extra help, PAP, SPAP etc. this is not all inclusive
How many vacation overrides in a year are member's allowed?
2
Who handles a opioid override?
HCPR
What are your main systems for pharmacy?
Rx Nova, Rx Connect Pro
How much does a member have to pay for their prescription when they hit the catastrophic stage?
0
What is error code 141?
Drug is excluded on plan Formulary
A member can refill a 30 day supply of their medications once they reach what percent days supply?
75 percent
What is it called when a member wants to appeal a denied authorization for medication?
Re-Determination
Does Humana cover lost stolen or damaged medications?
No
What is an exception override for a lost or damaged medication?
Natural Disaster Override
What is opioid naive?
opioid naive is simply a patient who is not used to taking opioid medications
How long is a standard appeal decision time frame?
72 hours
What primary system do you look up drug claim information in?
Rx Nova
What are some non clinical overrides?
COB, mail order delay, vacation
What is the day supply an opioid naive person can fill?
7 day supply however some states only allow a 3 day supply
What is the name of Humana's mail order pharmacy?
Centerwell
Who inputs a vacation override?
Pharmacy
What is error code 158?
NDC Not Covered without appropriate diagnosis code
How many days from last fill of an opioid are they considered opioid naive?
108 or greater for Medicare