True or False?
The privacy disclaimer must be read on all calls.
True.
What is the plan design for all med d accounts?
90VOL
How must every medication be priced on med d accounts?
90/90 Price comparison with a preferred pharmacy
What are the 4 common benefit stages, in order?
Deductible, initial, coverage gap, catastrophic
Member's current pharmacy is not preferred, and you need to do a price comparison
Do 90/90 price comparison for their current pharmacy as well as a local preferred pharmacy.
For Med D calls, we are required to ask about other members in the household.
False.
Is a member allowed to fill medications at a pharmacy that is not in network?
Yes, but they would only be able to fill 30 day supplies rather than 90
When are we required to read the pricing disclaimer?
Anytime a medication is priced or processed in the cart.
Do all medicare d accounts have all 4 benefit stages?
no
Member says they do not want to use home delivery.
Close the call. We never solicit medications for medicare D and only offer HD after they consent.
Two medications on a member's account can fall into different benefit stages at the same time.
True.
Which medications do not require consent from the member to review?
refills and renewals
How would we determine the qty to price for a medication?
Ask, "How often do you take this medication?"
or " How long does that inhaler usually last?"
Never ask 'How many times a day do you take this? Not all meds are taken daily and we cannot assume.
Where would you look up how much drug spend the member has accumulated this benefit year?
Benefits> Account Summary> select Drug spend from the drop down
Member wants to set up medications on a FUTURE ACTIVE account
Let them know that we are unable to price or request medications before the active date, and they can call back or we can schedule a call back with them.
If a benefit stage is not listed in drug coverage, you do not have to mention one.
True
What medications require consent for us to review with the member?
HD Opportunities
How do we determine if a medication is in stock?
CS. This is not in scope for MCC
What is Drug Spend?
The amount of the medication cost that the insurance + member has paid for in that benefit year.
You see "Held for approval to fill" on a medication on order status screen
Find the medication on the "Order Now" screen and add to cart.
This means the member has a consent on file that requires them to give consent to have new medications sent out.
We are able to tell a member what prices for meds will be for the following benefit year.
False
Are med d members required to use Home Delivery?
No. They can do 90 days supply at retail in network or through HD without penalty.
Which stage is usually the most expensive for the member?
Coverage Gap
What stage is also called the "Donut Hole"?
Coverage Gap Stage
Pricing in cart is much different than pricing from dcdp
Make sure you are pricing correct qty in dcdp. Check Account Summary to see if they are straddling benefit stages.