Design Document for:

Commercial Pharmacy Benefits Overview

By: Alyssa Haynes
Purpose of the Course

Audience Description

Major Course
Objectives (Terminal)

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Understanding Humanas basic commercial pharmacy products provides a

platform for success in future, more specific training for new hires to the
Pharmacy Benefits Team. Most new team members come from other
departments within the organization and have little or no pharmacy
exposure. Others come from outside of the organization and have no
knowledge of Humanas pharmacy products. Without this knowledge, a
new hire may become lost or frustrated when learning future content, and
may need re-training. This course will provide new employees with the
foundation knowledge of Humanas commercial pharmacy products, in
order to:
Improve recall when on the job
Apply in future, more specific modules
Reduce the need for re-training
The primary audience of this training is made of mostly millennials between
the ages of 21-35, all of which have a least a Bachelor's degree. The
audience is historically 80% female, 20% male, and almost exclusively
Caucasian. All of the primary learners are familiar with MS Excel, MS
Word and MS Power point, can work independently, and have demonstrated
problem solving abilities. Most have prior experience in a healthcare, retail
pharmacy, insurance or related setting, and all of the learners understand the
need to master product knowledge to be successful in their position.

New hires will be able to define basic pharmacy and Humana

terminology and acronyms without a job aid or notes with 80%
accuracy when given the final knowledge check

New hires will be able to list and describe each pharmacy plan
offered by Humana and define how the tier levels are grouped in
each product without the use of a job aid or notes

Given a benefits spreadsheet, new hires will be able to identify each

of the pharmacy plan types offered on the document

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Course Enabling
Objectives

New hires will be able to define basic pharmacy and Humana terminology
and acronyms without a job aid or notes with 80% accuracy when given the
final knowledge check

Define basic pharmacy benefits terms such as brand, generic,

deductible, maximum out of pocket, and high deductible health plan
without the use of a job aid or notes
Define basic Humana terms and acronyms such as Rx3, Rx4, Rx5,
DED and MOP without the use of a job aid or notes

New hires will be able to list and describe each pharmacy plan offered by
Humana and define how the tier levels are grouped in each product without
the use of a job aid or notes

Explain the difference between each of the copay plans (Rx3, Rx4,
and Rx5) without the use of a job aid or notes
Define the tier groupings of each pharmacy product with 80%
accuracy when given a final knowledge check
Clearly distinguish how a plan with a pharmacy deductible
functions differently than a plan without a deductible
Compare and contrast the catastrophic plan design, aggregate high
deductible health plan design, and embedded high deductible health
plan design without the use of a job aid or notes

Given a benefits spreadsheet, new hires will be able to identify each of the
pharmacy plan types offered on the document

RLO Enabling
Objective

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Given a benefits spreadsheet, locate all of the sections of the

document that are relevant to pharmacy
Given a benefits spreadsheet, identify the separate plans outlines on
the document
Clearly distinguish how a plan with a pharmacy deductible functions
differently than a plan without a deductible.

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Learning Assessment
for Course

The main form of assessment for this Commercial Pharmacy Benefits

Overview course will be short knowledge checks, or quizzes after each
module. A final review and summative assessment will be completed at the
end of the course.
Activities and discussions will also be used as a form of assessment. For
example, to show that a learner knows the different types of high deductible
health plans, small groups will complete a chart to compare and contrast
three different plan types. With these activities, the learner will also be able
to assess their own progress and discuss concerns with the instructor.

Learning Assessment
for RLO

Knowledge checks after each major section of the tutorial, and a larger
learning assessment (test) will complete the RLO. Types of questions will
include:

Pick one questions

Sequence questions (Ex - Put descriptions of paid claims outcomes

in chronological order on a labeled timeline)

Instructional Delivery This course will be delivered face to face in an instructor-led small group
method for Course
setting during the first week of hire. New hires will also participate in a
(overall)
CBT that provides self-paced examples of how pharmacy benefits function.
All new hires will have access to desktop workstations.
Instructional Strategy Self-paced tutorial developed in Adobe Captivate, existing Humana video
for RLO
(How Do Deductibles and Copays Work?), and quiz questions/knowledge
checks to help keep the learner engaged.
Media

The RLO will include a Humana video with sound and simple, nondistracting images and Humana brand logos. There may also be timelinetype graphics to demonstrate when claims process a certain way within a
plan (ex member pays 100% until the deductible is met).

508 Accommodations

Include alt tags for graphics, and transcripts or subtitles for video. If there is
a complex graphic, there will be a thorough text description to accompany it.
The design will utilize sufficient contrast, and will not include flickering or
flashing pages.

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Course Structure
Description

This is a 3 hour introductory course containing 3 modules:

Basic Terminology
Understanding the Different Pharmacy Plans and How They Work
Analyzing Identifying the Different Plans on a Benefits Spreadsheet
The RLO will occur within the second module and be a self-paced tutorial
with examples of how different pharmacy benefits function.

Seat Time of Course

The course will take no longer than 3 hours to complete.

Seat Time of RLO

The seat time for this RLO is around 15 minutes

RLO Outline

I.

II.

III.

IV.
V.

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Introduction
a. Summary of Topics
b. Importance
c. Objective
d. Overview (Humana Video)
Plans with a Deductible
a. HDHP/EHDHP Integrated Deductible
b. Rx3, Rx4, Rx5 Drug Deductible
c. How Claims Process When a Member Has Not Met Their
Deductible
i. Example
ii. Example
d. Split Claims
i. Example
e. How Claims Process When a Member Has Met Their
Deductible
i. Example
ii. Example
f. Knowledge Check
Plans without a Deductible
a. Rx3, Rx4, Rx5
b. How Claims Process When There is No Deductible
i. Example
ii. Example
c. Knowledge Check
Summary
Assessment

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RLO Flowchart
RLO Flowchart.pdf

http://hayneseportfolio.weebly.com/rlo-flowchart.html
Screens/Pages in RLO There will be around 28 screens for this course.
Knowledge Checks or There will be one knowledge check question after each of the two lessons,
Other Assessments or and one final assessment consisting of three questions
Practices for RLO
____Dichotomous (T/F, Y/N, etc.)
__4__Multiple Choice
____Multiple Select
__1__Drag and Drop
____Custom describe; if appropriate, supply flowchart in an Appendix
and reference it here.
____Other describe
Rollovers/click events

There will be rollovers to give additional information on plans with

deductibles, and plans without deductibles.
__3__Rollovers
____Click Events

RLO Navigation

Navigation will be controlled by the user with previous/next buttons. There

will be no timed/automatic transitions. Users will submit assessment
questions with a submit button.

Screen Layouts for

RLO

See Appendix A.

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Development Tools
for RLO

Storyboarding will be completed in PowerPoint.

Authoring tool will be Adobe Captivate 8.
Graphics will be created in PowerPoint and with Humanas Life Block tool.
Reusable content/images from the web will also be utilized.

Ownership

Development Time of
entire course and
RLO

Alyssa Haynes, will develop the initial course and, with the help of the
Pharmacy Benefits Team, will maintain the course. Should the department
continue to expand, other consultants assigned to curriculum development
will maintain the course as a team. The course is being developed for new
hires to Humanas Pharmacy Benefits and Eligibility team.
5-10 hours per week will be dedicated to developing this course and the
timeline will be as follows:
Develop comprehensive course outline including instructional
strategies and assessment methods 1-2 weeks
Develop all absorb materials (PowerPoint, job aids) outside of RLO
2 weeks
Develop RLO (including time to learn how to use software) 6
weeks
Develop assessment materials and activities outside of RLO 2
weeks
Present to team for feedback 1 week
Modify material 1 week
Work with Humana Pharmacy Learning Organization to add RLO to
The Learning Center Dependent on HPLO capacity

Support requirements Alyssa Haynes will be the SME for this course, though anyone on the team
for RLO and course
can request and suggest revisions and updates as needed. Humana
Pharmacy Learning Organization will have to provide support maintaining
and transferring updates to the RLO in The Learning Center.
Project
Sign-off [optional]

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Please sign below indicating agreement with the proposed course plan and
approving start-up of the storyboard and development phases.

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Instructional Designer

Date

Project Manager/Sponsor

Date

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Appendix A: Screen Layouts

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