Regarding Medicare Part D drug formularies, a plan must include at least:
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Medicare Part D plans are required to maintain a formulary that includes at least two drugs in each therapeutic category and class, with some exceptions for certain classes. This ensures beneficiaries have meaningful access to the medications they need rather than a token formulary. Plans must also cover substantially all drugs in certain protected classes. The two-drugs-per-category minimum is a specific tested requirement. The two-drug minimum is a formulary-access rule enforced by CMS to keep plans from offering token coverage in any class. Beyond the minimum, plans must treat protected classes such as immunosuppressants, antiretrovirals, and antipsychotics especially carefully, and every denial must be subject to exceptions, appeals, and expedited review.
Why the other options are wrong
- C) The minimum is two drugs per category and class, not one. One drug per category is below the CMS minimum; the formulary rule requires at least two drugs in each therapeutic category and class.
- D) There is no ten-drugs-per-condition requirement in Part D formulary rules. There is no ten-drugs-per-condition standard; the governing requirement is the two-drug minimum per therapeutic category and class. Formulary compliance is measured against the category and class standard instead.
- A) Part D plans cover both brand and generic drugs, subject to tiering and formulary design. Part D formularies may include both brand and generic drugs, and plans are not restricted to generics only.
Memory hook
Part D formularies promise at least two picks in every therapeutic aisle.