Benefit Stages
Name 3 recommendations for non cover medication.
*211
*Generic medication
*Patient assistance programs/ brand programs
* samples
* short refill
What happens to the accumulation for RX benefits at the end of the year?
they restart
Omeprazole is a tier 1 medication and Xifaxan is a tier 5 medication. Which medication will be on a higher cost for the member?
Xifaxan
Why is an authorization denied?
It's not medically necesary.
Name the RX benefit stages established by CMS are?
Deductible, initial coverage, catastrophic.
True or False:
All plans have deductible exceptions.
False
A member has a deductible of $545 with exclusion of Tier 1 & Tier 2, she has met her deductible and was prescribe a new medication tier 4. What will be the members responsability?
Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
$0 5$ $45 13% 25%
13%
What is the Humana universal greeting?
Hi, thank you for calling Humana my name is ___ your health care advocate for today?
True or False:
The 3 stages for part D coverage, restart if a member change of insurance company.
FAAALLLSSEEE
What happen is a member does not enroll in a drug plan when they first become eligible or choose to cancel their drug coverage?
They are at risk of getting a Late Enrollment Penalty.
A member has a deductible of $350 with tier 1 & 2 exceptions, copay tier 1: 5$ copay tier 2: 15$, no amount has been met for the deductible. Member needs to get a refill on his Atorvastatin tier 1 medication. What is going to be the members responsibility?
5
What is the complete verification of benefits cycle?
quote the benefit, check if authorization or referral is needed and check if the provider is in network
Please explain the benefits stages.
Trainer will provide you with H ID
.
What is the stage when the member will pay $0 for all medication?
catastrophic
REEEEEEEEAAADDD:
If a plan has a deductible for $500 with no exclusion, in January member need to purchase tier 3 medication that cost $387 at a negotiated rate. How much must the member pay for this tier 3 medication?
387
who in this room got shot?
Gerardo