Prescription Claims Refresher

Use Live Research: MID: 900990425

Jacqueline stated she cannot get her medication last June 21, 2023 and she wanted to know why. What is the reason of the rejection of the claim?

• Transitional Fill

• Plan exceeded limit

• Refill too soon

Use Live Research: MID: 900990425

Jacqueline is getting Lisinopril tab 20mg every month. She is asking what is the tier of her medicaiton?

• Tier 3

• Tier 1

• Tier 3

Use Live Research: MID: 010632727

Member asked you why is her medication Trazodone Tab last 50mg 7/18/2023 and 2/21/2023 decreased its cost. Member also stated that before it was $9 and some change, but it became $1.45. What was the reason of the change?

• SPAP

• LIS

• DMAP

Use Live Research: MID: 010632727

Member asked you why is her medication Trazodone Tab 50mg last 7/18/2023 and 5/22/2023 decreased its cost. Member also stated that it should be $1.45 throughout the year, so why she should pay a $9 and some change.

• Member don't have LIS from January to April and that is why she has to pay the amount of $9.67.

• Member is in coverage gap.

• Member has LIS 2 and that is why he has to pay that amount.

Use Live Research: MID: 010632727

What is the LIS of the member?

• 1

• 2

• 3

Use Live Research: MID: 010632727

Member called in asking about her prescription last 2/15/2023. She knew that it was rejected but dont know the reason, what should you do to help the member?

• Advised it is non-formulary and has an alternatives that she can try.

• Advised it is exclude and has an alternatives that she can try.

• Advised it is actually covered.

Use Live Research: MID: 010632727

Patricia stated that she tried to get a medication however she can't get it. She tried to get it last 11/16/2023. What is the reason of the rejection?

• The medication is not covered under the plan however, there is an alternative that may be offered.

• Refill too soon

• Not covered

Use Live Research: MID: 017484065

Member stated he tried to get why is she only paying $4.30 for her medication Jardiance 10mg tablet.

• Member is receiving an extra help coming from her Social Security which is LIS 2.

• She tried to get it in retail which prompt her to pay $4.30 only.

• The plan followed the "lesser logic" that is why it is only $4.30.

Use Live Research: MID: 017484065

Member called in wanted to know how much did the plan paid for her Jardiance last June 20, 2023. How much is the amount paid by the plan?

• $638.02

• $1920.26

• $0.00

Use Live Research: MID: 017484065

Member called in wanted to know why he has to pay for $30.60 for the pain reliever he tried to get last May 3, 2023. When you checked, it was rejected. What could be the reason?

• Medication is not covered under Part D.

• Refill too soon

• Plan exceeded the limit