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Prescriptions & Pharmacy

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1. Plan name and premium [Extra Help/Medicaid: Should be quoted from the LIS table and original premium of the plan]

2. Medical deductible

3. PCP & Specialist Copays

4. ER and inpatient hospital copays

5. Dental, Vision, and Hearing (if applicable)

6. Identify 1 PCP and at least offer to look up Specialist and Hospital networks
   

   

7. Pharmacy Deductible [Extra Help/Medicaid: Should be quoted from the LIS table and original deductible of the plan]

8. List at least 1 Preferred Pharmacy. If you originally selected a Standard Pharmacy click the “Pharmacy Directory” link to find a Preferred Pharmacy:
   

   

9. State that the mail order pharmacy is CVS Caremark
   

10. OPTION 1: Prescription Copays

    1. State copays applicable to member’s drugs [Example: “Your Metformin is a tier 1 Rx with a $__ copay. Your Eliquis is a tier 3 Rx with __% Coinsurance.”

    2. State copay amounts for each tier [Example: Tier 1 drugs have a $___ copay; Tier 2 drugs have a $ __ copay; etc] This must be stated when members say they do not currently have any prescriptions.

    3. State whether each tier applies to the deductible [Example: The deductible for this plan applies to tiers 3, 4, and 5. Some of your drugs are tier 3, so the deductible will apply to those drugs”]
       

    OPTION 2: Prescription copays/coinsurances for each tier.

11. Tier 1 are your preferred generics which have a $__copay. The deductible does/does not apply. The following drugs are tier 1: [name all applicable medications and costs].

12. Tier 2 are your generics which have a $__copay. The deductible does/does not apply. The following drugs are tier 2: [name all applicable medications and costs].

13. Tier 3 are your preferred brand name drugs which have a __% coinsurance. The deductible does/does not apply. The following drugs are tier 3: [name all applicable medications and costs].

14. Tier 4 are your non-preferred brand name drugs which have a __% coinsurance. The deductible does/does not apply. The following drugs are tier 4: [name all applicable medications and costs].

Tier 5 are your specialty drugs which have a __% coinsurance. The deductible does/does not apply. The following drugs are tier 5: [name all applicable medications and costs

for each drug. You MUST state each of the following items:

1. Restate the name of the medication.

2. State the tier of the medication.

3. State whether the deductible applies to the medication.

4. Quote the copay/coinsurance for each applicable phase of the drug.
   [Example: Eliquis is a tier 3 drug. The deductible will apply to this medication. Under the deducible phase, you will pay $__ (if applicable). Then, you will move to the initial coverage phase and will pay $__ (required). Next, you are projected to into what is called the Coverage Gap phase at which point your copay will be $__ (if applicable). Lastly, you are projected to into what is called the Catastrophic Coverage phase at which point your copay will be $__ (if applicable)].

12. Quote drug phases that are projected to apply to the caller. To Identify copays for the various phases (Coverage gap/Catastrophic coverage) the agent should go to the Total Costs Tab at the top.

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1311. State applicable drug restrictions for each medication [ie: Quantity Limits, Step Therapy, and Physician Authorization]

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1. Plan name and premium [Extra Help/Medicaid: Should be quoted from the LIS table and original premium of the plan]

2. Pharmacy Deductible [Extra Help/Medicaid: Should be quoted from the LIS table]

3. List at least 1 Preferred Pharmacy. If you originally selected a Standard Pharmacy click the Pharmacy Directory link to find a Preferred Pharmacy:
   

   

4. State that the mail order pharmacy is CVS Caremark

5. Prescription Copays

   State copays for each tier [Example: Tier 1 drugs have a $___ copay; Tier 2 drugs have a $ __ copay; etc] This must be stated regardless of whether the member currently has any prescriptions

   for each drug. You MUST state each of the following items:

   1. Restate the name of the medication.

   2. State the tier of the medication.

   3. State whether the tier deductible applies to the deductible the medication.

   4. Quote the copay/coinsurance for each applicable phase of the drug.
      [Example: Eliquis is a tier 3 drug. The deductible for this plan applies to tiers 3, 4, and 5. Some of your drugs are tier 3 so the deductible will apply to those drugs”]

   5. Quote drug phases that are projected to apply to the caller (To Identify copays for the various phases (Coverage gap/Catastrophic coverage) the caller will go to the Total Costs Tab at the top)
      

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   6. will apply to this medication. Under the deducible phase, you will pay $__ (if applicable). Then, you will move to the initial coverage phase and will pay $__ (required). Next, you are projected to into what is called the Coverage Gap phase at which point your copay will be $__ (if applicable). Lastly, you are projected to into what is called the Catastrophic Coverage phase at which point your copay will be $__ (if applicable)].

6. State applicable drug restrictions for each medication [ie: Quantity Limits, Step Therapy, and Physician Authorization]

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Closing the Sale

Remember to ask for the sale

If Yes:

• Move to Enrollment section - send the quick quote and read the following email disclaimer:

  • "Providing an email address authorizes us to contact you via email. Your email address will be handled consistent with our Privacy Policy, which you can find on our website at www.aetnamedicare.com”

• Inform caller they will get 2 emails (check SPAM folders)

• Proceed to the Enrollment Checklist Tab in Contact Center

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