Under Medicare Part D, what formulary requirement must a prescription drug plan meet?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
A Medicare Part D plan's formulary, its list of covered drugs, must include at least two drugs in each therapeutic category and class, so that beneficiaries in every drug class have real choices. Plans may structure tiers, preferred pharmacies, and prior authorization, but the formulary cannot leave an entire drug category empty. The requirement supports access to a broad range of therapies while still allowing plans to manage costs. Beneficiaries can also request formulary exceptions and must be notified when a drug they take is moved to a different tier or removed from the formulary.
Why the other options are wrong
- B) Part D formularies must include brand and generic options; limiting a formulary to brands only would defeat cost management.
- C) The minimum is two drugs per category and class, not five, and plans can cover many more as they choose.
- D) Generics are the backbone of Part D formularies; excluding them would make coverage unaffordable and violate the plan's access standards.
Memory hook
Part D's rule of two: every drug class needs at least a pair of covered choices.