Question

When discussing prescription drug coverage, you should:

a.Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits).
b.Confirm coverage of the beneficiary's current and/or anticipated prescriptions.
c.Explain formulary tiers as well as drug copayment amounts.
d.For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception.

Answer 1

When discussing prescription drug coverage, it is important to explain how to navigate the formulary, confirm coverage of prescriptions, understand formulary tiers and copayment amounts, and learn about the Transition Fill program and coverage exception requests.

Step-by-step explanation:

When discussing prescription drug coverage, there are several important things to consider:

1. Explain how to use the formulary to look up limitations and exclusions: The formulary is a list of prescription drugs covered by the plan. Students should explain how to navigate the formulary to understand any limitations or exclusions, such as step therapy or quantity limits.
2. Confirm coverage of the beneficiary's prescriptions: Students should explain how to check if the beneficiary's current or anticipated prescriptions are covered by the plan.
3. Explain formulary tiers and drug copayment amounts: Students should discuss the different tiers within the formulary and the corresponding copayment amounts for each tier.
4. Discuss the Transition Fill program and coverage exception requests: Students should describe the Transition Fill program, which provides temporary coverage for drugs not covered by the new plan. Additionally, they should explain how to request a coverage exception for specific medications.