2014 - Ba - Readiness Quiz 4 - Ga/Df

1. What step would you take if a drug is identified as non-covered?

Re-verify the drug with the customer

Check for the correct spelling of the drug

Check drug on Medicare.gov

All of the above

If a drug is identified as non-covered, it is important to take the following steps: re-verify the drug with the customer to ensure accuracy, check for the correct spelling of the drug to avoid any confusion, and check the drug on Medicare.gov to determine its coverage status. By doing all of the above, you can ensure that the drug is properly identified and determine the appropriate course of action.

Explanation

If a drug is identified as non-covered, it is important to take the following steps: re-verify the drug with the customer to ensure accuracy, check for the correct spelling of the drug to avoid any confusion, and check the drug on Medicare.gov to determine its coverage status. By doing all of the above, you can ensure that the drug is properly identified and determine the appropriate course of action.

2. Which of the following would be identified as a deductible for a PDP?

A standard amount you pay based on a tier level

A fixed amount that must be paid before the plan pays

A percentage of the cost that must be paid to the pharmacy

Deductibles for PDP are not required

A deductible for a PDP refers to a fixed amount that an individual must pay out of pocket before their insurance plan starts covering the costs. This amount is predetermined and does not change based on the tier level or the cost of the prescription. Once the deductible is met, the insurance plan will then begin to pay for the covered expenses. Therefore, the correct answer is "A fixed amount that must be paid before the plan pays."

Explanation

A deductible for a PDP refers to a fixed amount that an individual must pay out of pocket before their insurance plan starts covering the costs. This amount is predetermined and does not change based on the tier level or the cost of the prescription. Once the deductible is met, the insurance plan will then begin to pay for the covered expenses. Therefore, the correct answer is "A fixed amount that must be paid before the plan pays."

3. Which pharmacy would you expect to get a lower cost for covered drugs?

Network Pharmacy

Long Term Care Pharmacy

Preferred Network Pharmacy

There is no difference in costs on Medicare PDP’s

A Preferred Network Pharmacy is likely to offer a lower cost for covered drugs compared to other types of pharmacies. This is because Preferred Network Pharmacies have negotiated agreements with Medicare Part D plans to provide discounted prices on prescription medications. These pharmacies are part of a network that has been selected by the plan based on factors such as cost, quality, and convenience. By using a Preferred Network Pharmacy, Medicare beneficiaries can take advantage of the lower cost options available to them.

Explanation

A Preferred Network Pharmacy is likely to offer a lower cost for covered drugs compared to other types of pharmacies. This is because Preferred Network Pharmacies have negotiated agreements with Medicare Part D plans to provide discounted prices on prescription medications. These pharmacies are part of a network that has been selected by the plan based on factors such as cost, quality, and convenience. By using a Preferred Network Pharmacy, Medicare beneficiaries can take advantage of the lower cost options available to them.

4. No special consideration is needed on selecting a plan for someone who is in a nursing home.

True

False

Special consideration is needed when selecting a plan for someone who is in a nursing home. Nursing home residents often have unique healthcare needs and require specialized care. Factors such as medication management, assistance with daily activities, and coordination of medical services need to be taken into account when choosing a plan for someone in a nursing home. Therefore, the statement that no special consideration is needed is false.

Explanation

Special consideration is needed when selecting a plan for someone who is in a nursing home. Nursing home residents often have unique healthcare needs and require specialized care. Factors such as medication management, assistance with daily activities, and coordination of medical services need to be taken into account when choosing a plan for someone in a nursing home. Therefore, the statement that no special consideration is needed is false.

5. Which of the following descriptions would best describe a drug restriction?

Cost

Tier level

Non-network Pharmacy

Step therapy

Step therapy is a drug restriction that requires patients to first try and fail on a less expensive or preferred medication before they can access a more expensive or non-preferred medication. This approach aims to control costs and promote the use of more cost-effective treatments. It is a common practice used by insurance companies and healthcare providers to ensure appropriate and cost-efficient use of medications.

Explanation

Step therapy is a drug restriction that requires patients to first try and fail on a less expensive or preferred medication before they can access a more expensive or non-preferred medication. This approach aims to control costs and promote the use of more cost-effective treatments. It is a common practice used by insurance companies and healthcare providers to ensure appropriate and cost-efficient use of medications.

6. Prescription drug plans do not require a deductible to be paid for mail orders.

True

False

Prescription drug plans do require a deductible to be paid for mail orders.

Explanation

Prescription drug plans do require a deductible to be paid for mail orders.

7. OTC (over the counter) drugs are important to the health of a customer. It is important to collect this information so the customer will have a fair comparison of their total monthly drug cost.

True

False

Collecting information about OTC drugs is not important for customers to have a fair comparison of their total monthly drug cost. OTC drugs are typically purchased without a prescription and are not covered by insurance plans. Therefore, their cost is not typically factored into the total monthly drug cost calculation.

Explanation

Collecting information about OTC drugs is not important for customers to have a fair comparison of their total monthly drug cost. OTC drugs are typically purchased without a prescription and are not covered by insurance plans. Therefore, their cost is not typically factored into the total monthly drug cost calculation.

8. A non-preferred generic drug is identified as which tier level in most plans?

Tier 1

Tier 2

Tier 3

Tier 4

A non-preferred generic drug is identified as Tier 2 in most plans. This means that it is still a generic drug, but it is not the preferred option and may have a higher cost compared to Tier 1 drugs. Tier 2 drugs generally have a higher copayment or coinsurance amount than Tier 1 drugs, but they are still typically more affordable than brand-name drugs or drugs in higher tiers.

Explanation

A non-preferred generic drug is identified as Tier 2 in most plans. This means that it is still a generic drug, but it is not the preferred option and may have a higher cost compared to Tier 1 drugs. Tier 2 drugs generally have a higher copayment or coinsurance amount than Tier 1 drugs, but they are still typically more affordable than brand-name drugs or drugs in higher tiers.

9. Certain drugs are covered in some plans but not others. A customer demands to know why his drug is not covered. Which of the following would you tell the customer?

Some carriers cannot afford to cover the drug

Some carriers do not want the risk of providing the drug

The drug is not listed in the formulary

All of the above

The customer is informed that the reason his drug is not covered is because it is not listed in the formulary. This means that the specific drug is not included in the list of medications covered by the insurance plan. It could be due to various reasons such as the drug being too expensive for certain carriers to afford or carriers not wanting to take on the risk associated with providing the drug. However, the main reason is that it is simply not included in the formulary.

Explanation

The customer is informed that the reason his drug is not covered is because it is not listed in the formulary. This means that the specific drug is not included in the list of medications covered by the insurance plan. It could be due to various reasons such as the drug being too expensive for certain carriers to afford or carriers not wanting to take on the risk associated with providing the drug. However, the main reason is that it is simply not included in the formulary.

10. A non-preferred brand drug is identified as which tier level in most plans?

Tier 1

Tier 2

Tier 3

Tier 4

A non-preferred brand drug is identified as Tier 4 in most plans. This tier level indicates that the drug is not preferred by the insurance plan and may have higher out-of-pocket costs for the patient compared to drugs in lower tiers. Tier 4 drugs are typically more expensive or have alternative options available that are preferred by the plan.

Explanation

A non-preferred brand drug is identified as Tier 4 in most plans. This tier level indicates that the drug is not preferred by the insurance plan and may have higher out-of-pocket costs for the patient compared to drugs in lower tiers. Tier 4 drugs are typically more expensive or have alternative options available that are preferred by the plan.

11. When searching for a PCP number for a Humana MAPD, what resources should you use? (Check all that apply)

NPI Registry

Humana Physician Finder

Call the doctor’s office

Type in the doctor’s name and phone number

The correct answer is Humana Physician Finder. When searching for a PCP number for a Humana MAPD, the recommended resource to use is the Humana Physician Finder. This tool allows you to search for doctors within the Humana network and provides information such as their contact details and PCP number. The NPI Registry can be used to find a doctor's National Provider Identifier, but it may not provide specific information about their affiliation with Humana. Calling the doctor's office or typing in their name and phone number may not necessarily provide the PCP number for a Humana MAPD.

Explanation

The correct answer is Humana Physician Finder. When searching for a PCP number for a Humana MAPD, the recommended resource to use is the Humana Physician Finder. This tool allows you to search for doctors within the Humana network and provides information such as their contact details and PCP number. The NPI Registry can be used to find a doctor's National Provider Identifier, but it may not provide specific information about their affiliation with Humana. Calling the doctor's office or typing in their name and phone number may not necessarily provide the PCP number for a Humana MAPD.