AHIP Medicare Part D Prescription Drug Plans 2

Question 1

A Part D plan's tier structure typically places generic drugs in which tier?

Accepted Answer

Tier 1 (lowest cost-sharing)

Answer

Tier 4 (Specialty)

Answer

Tier 3 (Preferred Brand)

Answer

Tier 2 (Non-Preferred)

Question 2

What is 'step therapy' in a Medicare Part D plan?

Accepted Answer

A requirement to try lower-cost drugs before a plan covers a preferred drug

Answer

A graduated deductible that decreases over time

Answer

A multi-step enrollment process

Answer

Tiered cost-sharing based on pharmacy type

Question 3

Which of the following is a beneficiary's right when a Part D plan denies coverage of a drug?

Accepted Answer

Request an exception or file an appeal

Answer

No recourse; plan decisions are final

Answer

Only request a formulary change at the next plan year

Answer

Switch pharmacies to override the denial

Question 4

A 'Medication Therapy Management' (MTM) program in Part D is designed to:

Accepted Answer

Help beneficiaries with complex drug regimens use medications safely and effectively

Answer

Reduce plan premiums for healthy members

Answer

Limit the number of prescriptions a member can fill per month

Answer

Replace physician prescribing authority

Question 5

Stand-alone Part D Prescription Drug Plans (PDPs) are available to beneficiaries enrolled in:

Accepted Answer

Original Medicare (Parts A and/or B)

Answer

Medicare Advantage plans only

Answer

Medicaid only

Answer

TRICARE only

Question 6

What is the purpose of CMS's Prescription Drug Plan (PDP) formulary exception process?

Accepted Answer

To allow beneficiaries to request coverage for a non-formulary drug when medically necessary

Answer

To allow plans to remove drugs from their formulary at any time

Answer

To permit pharmacies to substitute brand drugs with generics

Answer

To let plans change cost-sharing tiers mid-year