Mispronounced names
Adervastyn
Atorvastatin
What does it mean if a drug has a step therapy restriction?
The plan requires you to first try certain drugs to treat your medical condition before they will cover another drug for that condition
If you have Medicare and Medicaid, you are considered dual-eligible and can qualify for plans called ___________.
DSNP’s
A drug that is not listed on the formulary is referred to as _________
Non-formulary
Sciritsy
Skyrizi
In-network pharmacies can consist of _________ and ___________ pharmacies
Standard / preferred
You’ll automatically get ___________ when you sign up for Medicaid
Extra Help/LIS
When gathering medications, it’s important to collect what 3 pieces of information?
Drug name, dosage, and frequency of usage
Truly City
Trulicity
A copay cap was set on insulin products. What is the copay cap for a month’s supply of insulin?
$35
Medicaid is a program that is run jointly by the ___________ and ____________.
State and federal government
A non-formulary drug might be covered by a plan if what is submitted?
Formulary exception
Extra Dial
Estradiol
A medication that is administered to a patient in an outpatient hospital setting would be covered under what Part of Medicare?
Part B
Some states let you ________ the amount of your income that’s above the state’s Medicaid limit.
Spend down
If a tier copay is too expensive for a prospect, they could submit a form for _____________. (Hint: Not a program)
A tiering exception
Foot Diva
Fotivda
What are all of the required costs that need to be reviewed for a PDP enrollment?
Premium, drug deductible, all tier copays, and any restrictions on the prospect’s medications.
Medicaid recipients have 4 SEP’s that they could qualify for. Name 3 of the 4 SEP’s.
Change in status SEP / monthly Part D (PDP) SEP / Integrated Care SEP (integrated SNP) / following an auto-enrollment by CMS or State
In 2025, when a person reaches the out-of-pocket cap of ________, they automatically enter catastrophic coverage.