2025 PDP January Readiness B and E

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Based upon what you have learned from the Opioid Safety Issues video, answer each of the following questions. NOTE: For a better experience, turn on the sound, then click Start to begin.

TBD: EGHP Call Driver Knowledge Check

EMPEZAR

C. The formulary would display as "Pain Killers".

B. The formulary would display as "Opioids".

A. The therapeutic class and sub-class section on the formulary would display as "Narcotic Analgesics".

1. How can you identify if the medication a member is taking is an opioid?

QUESTION 1/4

CS 2025 PDP Prescription Basics

Explanation: The therapeutic class and sub-class section on the formulary would display as "Narcotic Analgesics".

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QUESTION 2/4

CS 2025 PDP Prescription Basics

2. How would you explain to a member the reason they may be unable to obtain a 30-day supply of medication immediately after it was prescribed by their doctor?

C. Advised that the local pharmacy is monitoring their medication use.

B. Refer them back to their doctor for explanation.

A. Educate the member that there is a safety precaution for opioid medications that requires them to use a seven-day supply first.

Explanation: Educate the member that there is a safety precaution for opioid medications that requires them to use a seven-day supply first.

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C. Call the local pharmacy to reprocess a 7-day fill. Advise Mrs. Martin that after the 7-day initial fill, she will need to get a new prescription for the 30-day supply of the medication.

B. Educate the member that you will be transferring the call to Pharmacy Help desk for further assistance.

A. Since the medication is newly prescribed to the member, the call should be warm transferred to the Pharmacy Help Desk.

3. Mrs. Martin just got home from a doctor’s office visit and was prescribed a new medication, Tramadol 50 mg tablet, 1 tablet/day. She contacts customer service because her medication is being denied at the Walgreens pharmacy. You access CSP and you see the rejection 925. How would you assist the member?

QUESTION 3/4

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Explanation: Call the local pharmacy to reprocess a 7-day fill. Advise Mrs. Martin that after the 7-day initial fill, she will need to get a new prescription for the 30-day supply of the medication.

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D. All of the above.

C. Transfer the call to Pharmacy Help desk for further assistance.

B. Check the claim in CSP and confirm if the rejection code is 925.

A. Empathize with the member and offer assistance.

4. Mr. Collins has been taking Methadone 10 mg tablet for years and was surprised that his claim was rejected at the Walmart pharmacy. He became upset and stated that he needed his medication immediately. How would you assist Mr. Collins?

QUESTION 4/4

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Explanation: Answer choice D: All of the above.

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