1|Page
2025 Wellcare ACT Mastery Exam |
Comprehensive Q$A For Certification
Success
The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective
1/1/2024 will impact which plan(s)? -correct-answer-Both PDP & MAPD
A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories
depending on the level of need. -correct-answer-Four
The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin
copays for all insulins and insulin-combination products that are on the formulary,
regardless of tier, and are included in the $35 cap for one month's supply. -
correct-answer-True
Wellcare's 2024 product expansion represents a __% increase from 2023. -correct-
answer-One
CVS Caremark Mail Order will be in-network for 2024. -correct-answer-False
,2|Page
Which Prescription Drug Plan (PDP) product has the richest formulary with the
most adherence generics on Tier 1? -correct-answer-Value Plus
Centene requires all contracted brokers/agents to read, understand, and agree to
Centene's Business Ethics and Code of Conduct Policy. -correct-answer-True
Communication of PHI can be: -correct-answer-Written, Electronic, Verbal
From October 1 to October 14, certain activities are Non-Permissible Activities.
These include:
Assist with completing an application
Collect a completed application
Advise the beneficiary to complete an application prior to October 15. -correct-
answer-All of these
Member PHI can be stored on an external hard drive or a cloud storage service
like Google Drive or Apple Cloud. -correct-answer-False
, 3|Page
Which option is the preferred method to submit enrollment? -correct-answer-
Ascend Web/Mobile Application
When discussing prescription drug coverage, you should: -correct-answer-Explain
how to use the formulary to look up limitations and exclusions (e.g., step therapy,
quantity limits).
Confirm coverage of the beneficiary's current and/or anticipated prescriptions.
Explain formulary tiers as well as drug copayment amounts.
For drugs that are not covered by the new plan, explain the Transition Fill program
and how to request a coverage exception.
Which is an example of a top beneficiary complaint that affects Star Ratings? -
correct-answer-The beneficiary did not understand that enrolling in a Wellcare
plan would change their current Medicare Advantage plan.
Members who fail to pay the required premiums before the end of the grace
period (Wellcare has a three-month grace period) will be terminated. -correct-
answer-True
2025 Wellcare ACT Mastery Exam |
Comprehensive Q$A For Certification
Success
The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective
1/1/2024 will impact which plan(s)? -correct-answer-Both PDP & MAPD
A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories
depending on the level of need. -correct-answer-Four
The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin
copays for all insulins and insulin-combination products that are on the formulary,
regardless of tier, and are included in the $35 cap for one month's supply. -
correct-answer-True
Wellcare's 2024 product expansion represents a __% increase from 2023. -correct-
answer-One
CVS Caremark Mail Order will be in-network for 2024. -correct-answer-False
,2|Page
Which Prescription Drug Plan (PDP) product has the richest formulary with the
most adherence generics on Tier 1? -correct-answer-Value Plus
Centene requires all contracted brokers/agents to read, understand, and agree to
Centene's Business Ethics and Code of Conduct Policy. -correct-answer-True
Communication of PHI can be: -correct-answer-Written, Electronic, Verbal
From October 1 to October 14, certain activities are Non-Permissible Activities.
These include:
Assist with completing an application
Collect a completed application
Advise the beneficiary to complete an application prior to October 15. -correct-
answer-All of these
Member PHI can be stored on an external hard drive or a cloud storage service
like Google Drive or Apple Cloud. -correct-answer-False
, 3|Page
Which option is the preferred method to submit enrollment? -correct-answer-
Ascend Web/Mobile Application
When discussing prescription drug coverage, you should: -correct-answer-Explain
how to use the formulary to look up limitations and exclusions (e.g., step therapy,
quantity limits).
Confirm coverage of the beneficiary's current and/or anticipated prescriptions.
Explain formulary tiers as well as drug copayment amounts.
For drugs that are not covered by the new plan, explain the Transition Fill program
and how to request a coverage exception.
Which is an example of a top beneficiary complaint that affects Star Ratings? -
correct-answer-The beneficiary did not understand that enrolling in a Wellcare
plan would change their current Medicare Advantage plan.
Members who fail to pay the required premiums before the end of the grace
period (Wellcare has a three-month grace period) will be terminated. -correct-
answer-True
