Medicare Part D Prescription Drug Plans Flashcards
6 cards from real AHIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Medicare Part D Prescription Drug Plans flashcards as text
A Part D plan's tier structure typically places generic drugs in which tier?
Answer: Tier 1 (lowest cost-sharing)
Generics are typically placed in Tier 1, which has the lowest cost-sharing, encouraging use of lower-cost alternatives.
What is 'step therapy' in a Medicare Part D plan?
Answer: A requirement to try lower-cost drugs before a plan covers a preferred drug
Step therapy requires beneficiaries to try one or more alternative (usually less expensive) drugs before the plan will cover the originally prescribed medication.
Which of the following is a beneficiary's right when a Part D plan denies coverage of a drug?
Answer: Request an exception or file an appeal
Beneficiaries have the right to request a formulary exception or appeal a coverage determination if a drug is denied.
A 'Medication Therapy Management' (MTM) program in Part D is designed to:
Answer: Help beneficiaries with complex drug regimens use medications safely and effectively
MTM programs are designed to improve outcomes for beneficiaries with multiple chronic conditions and complex medication regimens.
Stand-alone Part D Prescription Drug Plans (PDPs) are available to beneficiaries enrolled in:
Answer: Original Medicare (Parts A and/or B)
Stand-alone PDPs are available to beneficiaries enrolled in Original Medicare to add drug coverage.
What is the purpose of CMS's Prescription Drug Plan (PDP) formulary exception process?
Answer: To allow beneficiaries to request coverage for a non-formulary drug when medically necessary
The exception process allows a beneficiary (or their prescriber) to request that the plan cover a non-formulary drug when there is a medical necessity.