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WorksheetsTheoric Medicare Rx Assessment
Total questions: 17
Worksheet time: 4hrs 15mins
If I get a PDP call, I should handle it as any other pharmacy call
True
False
If I get a MAPD call, I should handle it as normal.
True
False
The deductible commonly applies for the following drug tiers (Select all that apply):
Tier 2
Tier 4
Tier 5
Tier 3
The amount a member must pay for drugs before their insurance begins to pay its share.
Co-payment
Troop
Deductible
Co-Insurance
What is the initial coverage limit?
$4,130
$4,660
$4,430
$7,400
What is the Troop for 2023:
$4,430
$6,550
$7,050
$7,400
If a member wants to report a COB is terminated what is the right process?
Collect the previous insurance info including the termination date and send tracker to GOV-COBMSP
Do a conference call with the coordination of benefits contractor at 855-798-2627
Member must call the other insurance to cancel that.
How much a member must pay for drugs during initial coverage if they have LIS C
Generics $0.00
Brands $0.00
Generics: 15%
Brands: 15%
Generics $4.15
Brands $10.35
Generics $1.45
Brands $4.30
Check on the formulary if the following medication Oxandrolone tab 2.5mg, has any limitation and what is the tier. (such as QL, PA or ST)
Tier 3
and needs PA
Tier 3
and has QL
Tier 2
and needs PA
Tier 2
and has ST
What are the step 1 medications for Febuxostat 80 mg table?(select all that apply)
Probenecid tab 500 mg
Alendronate tab 70 mg
Allopurinol 100mg tablet
Allopurinol 300mg tablet
From which states does Cigna receive SPAP information? (select all that apply)
Pennsylvania
Alabama
Maryland
Delaware
If Lep has already been applied in the account (charge), I can still do an attestattion
True
False
Based on the inflation reduction act, what is the copayment for shingles shot and toujeo solostar if a member has a C-SNP plan on coverage gap?
Plan defined cost share, which is less than $35 and and $42 copay for Shingrix
$35 or 5% (minimum of $10.35), whichever is less and $42 copay for Shingrix
$35 or 25%, whichever is less and $0 copay for Shingrix.
What is the reconsideration form timeframe?
7-14 calendar days
up to 14 calendar days
7-14 business days
Up to 14 business days
How long does a member have to start an appeal if they don't agree with their CD denial?
30 days
60 days
60 calendar days
They can do it at any time
If Cigna Grants a customer's request to cover a drug that is NOT on our drug list, the drug will have a tier 4 copay
True
False
How many overrides a member can do?
2 overrides per medication per year
1 overrides per medication per year
