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

Generics are typically placed in Tier 1, which has the lowest cost-sharing, encouraging use of lower-cost alternatives.

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

Step therapy requires beneficiaries to try one or more alternative (usually less expensive) drugs before the plan will cover the originally prescribed medication.

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

Beneficiaries have the right to request a formulary exception or appeal a coverage determination if a drug is denied.

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

MTM programs are designed to improve outcomes for beneficiaries with multiple chronic conditions and complex medication regimens.

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

Stand-alone PDPs are available to beneficiaries enrolled in Original Medicare to add drug coverage.

AHIP - America's Health Insurance Plans Practice Test

AHIP - America's Health Insurance Plans Practice Test

AHIP Medicare Part D Prescription Drug Plans 2