FCR or Open?

Create an illustration depicting a healthcare professional reviewing medication coverage decisions, with a backdrop of pharmacy and patient-related imagery, in a contemporary style.

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

6 Questions2 MinutesCreated by AnalyzingPatient831

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

FCR or Open?

Medication Coverage Decision Quiz

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