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

Plans may make certain mid-year formulary changes but must obtain CMS approval and provide enrollees adequate advance notice.

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

Transition fills provide new enrollees a temporary supply of a non-formulary drug while they work with their doctor to find an alternative or request an exception.

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

Sponsoring organizations (private insurers) submit annual bids to CMS detailing their plan design, formulary, and projected costs.

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

CMS calculates the national base beneficiary premium annually; it is used as the basis for computing the Part D late enrollment penalty and LIS subsidy amounts.

Question 5

Preferred pharmacy networks in Part D are designed to:

Accepted Answer

Offer lower cost-sharing when members use designated pharmacies

Answer

Preferred pharmacy networks give beneficiaries lower cost-sharing at select pharmacies, incentivizing use of cost-efficient pharmacy partners.

AHIP - America's Health Insurance Plans Practice Test

AHIP - America's Health Insurance Plans Practice Test

AHIP Medicare Part D Prescription Drug Plans 3