Under Medicare Part D rules, a plan's formulary must include:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Medicare Part D plans maintain formularies, the lists of covered prescription drugs that define what the drug benefit will pay for. CMS requires each Part D formulary to include at least two drugs in each therapeutic category and class, ensuring that beneficiaries have meaningful choices within every treatment category. Plans may use formulary tiers, prior authorization, and step therapy, but the two-drug minimum protects access and prevents plans from covering a single drug in a category. This minimum is an exact regulatory number in the objectives and should not be confused with an open-formulary requirement, which Part D does not impose.
Why the other options are wrong
- B) Part D formularies must include generic drugs; generics are a staple of every plan's drug list. A brand-only formulary would be unaffordable and is not permitted.
- C) The requirement is two drugs per therapeutic category and class, not one. A formulary covering only a single drug in a category would fail the CMS standard.
- D) Plans are not required to cover every FDA-approved drug. They select a formulary that meets the category and class minimums while managing costs through tiers and utilization rules.
Memory hook
Part D formulary = at least two of every kind. One drug per category is not enough.