FCR or Open?
Medication Coverage Decision Quiz
Test your knowledge on the complexities of medication coverage decisions with our interactive quiz! This quiz consists of 6 scenarios that challenge your understanding of coverage grievances and how to address them effectively.
- Explore real-life scenarios
- Improve your grasp of FCR and Open QOC classifications
- Enhance your decision-making skills in healthcare settings
Member is out of medication because PA for her Oxycodone 10 mg tablets was expired. Member expressed dissatisfaction that she was never notified of the denial and now will be out of medication as she cannot afford the out-of-pocket cost.
Open QOC
FCR Exceptions Coverage Decisions
Not a valid grievance
Member expressed dissatisfaction because she is completely out of her insulin that she needs to take every day because the plan denied her coverage determination request. Member needs to take certain insulin due to allergies and needs us to approve non-formulary medication as soon as possible
Open QOC
FCR Exceptions Coverage Decisions
Not a valid grievance
Member is out of medication because we sent her the wrong strength of her Atorvastatin. Member is okay because she has 20 mg that she can take 2 pills of to equal the 40 mg she needs
Open QOC
FCR Mail Order
Non-Grievance Item
Member expressed dissatisfaction because CMS facilitated their enrollment into Part D plan against their wishes
Open QOC
Open CMS issue
FCR CMS Issues
Non-Grievance Item
Member is very frustrated that he medications are being sent from mail order in multiple different orders. Member only wants 1 box of all of her medications sent at one time moving forward
Open (Pharmacy)
FCR (Pharmacy)
Non-Grievance Item
Member expressed dissatisfaction with Walgreens pharmacist because they refused to fill her C2 prescription and she needs the medication as soon as possible
Open (Pharmacy)
FCR (Pharmacy)
Non-Grievance Item
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