AHIP 2024 Module 3 - Part D Drug Management Tools Covered
Drug and Formulary Requirements
Question 1: What tools can Medicare Part D prescription drug plans use to affect the way their enrollees
access medications?
Answer: Part D plans do not have to cover all medications. As a result, thei...
AHIP 2024 Module 3 - Part D Drug Management Tools Covered
Drug and Formulary Requirements
Question 1: What tools can Medicare Part D prescription drug plans use to affect the way their enrollees
access medications?
Answer: Part D plans do not have to cover all medications. As a result, their formularies, or lists of
covered drugs, will vary from plan to plan. In addition, they can use cost containment techniques such as
tiered co-payments and prior authorization.
Question 2: Mrs. Allen is concerned about finding a Medicare Part D prescription drug plan that covers
her brand name medications with no generic alternatives. What should you tell her?
Answer: Medicare prescription drug plans are required to cover drugs in each therapeutic category. She
should be able to enroll in a Medicare prescription drug plan that covers the medications she needs.
Question 3: Mr. and Mrs. Vaughn take prescription medications for medical needs. What should you tell
them about coverage under Medicare Part D?
Answer: Medicare prescription drug plans are not permitted to cover the prescription medications the
Vaughns are interested in under Part D coverage, however, plans may cover them as supplemental
benefits and the Vaughns could look into that possibility.
Question 4: Under what conditions can a Medicare prescription drug plan reduce its coverage for a given
drug during the first 60 days of the year?
Answer: Under no conditions can a Medicare Part D prescription drug plan reduce its coverage for a
given drug at any point during the year.
Question 5: How may a Part D sponsor address beneficiaries who are at risk of misusing or abusing
frequently abused drugs?
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