AHIP Medicare Part D Prescription Drug Plans 3

Question 1

Under which circumstance can a Part D plan change its formulary mid-year?

Accepted Answer

Only if CMS approves the change and enrollees are given proper notice

Answer

Anytime the plan chooses without restriction

Answer

Plans can never change the formulary mid-year

Answer

Only when a drug manufacturer raises the price

Question 2

What is the 'transition fill' policy in Medicare Part D?

Accepted Answer

A temporary supply of a drug provided when a new enrollee's drug is not on the plan's formulary

Answer

A free 90-day supply given at enrollment

Answer

A policy allowing beneficiaries to transfer to any pharmacy

Answer

A subsidy for insulin costs during transitions

Question 3

Which entity submits bids to CMS each year outlining a Part D plan's benefit design and premium?

Accepted Answer

Sponsoring plan organizations (private insurers)

Answer

State insurance commissioners

Answer

Individual pharmacies

Answer

Hospital systems

Question 4

What is the 'national base beneficiary premium' for Part D?

Accepted Answer

A benchmark CMS calculates annually used to determine premium subsidies and late penalties

Answer

The maximum premium any plan can charge

Answer

The minimum premium all plans must charge

Answer

The Medicaid contribution to Part D costs

Question 5

Preferred pharmacy networks in Part D are designed to:

Accepted Answer

Offer lower cost-sharing when members use designated pharmacies

Answer

Limit enrollees to a single pharmacy chain

Answer

Replace mail-order pharmacy options

Answer

Apply only to specialty drug tiers

Question 6

In Medicare Part D, 'quantity limits' are a utilization management tool that:

Accepted Answer

Restrict the amount of a drug dispensed per fill or time period based on clinical guidelines

Answer

Cap the number of prescriptions per month regardless of drug type

Answer

Limit the total annual drug spend to a set dollar amount

Answer

Apply only to Schedule II controlled substances