2025 Elevance Part D PlansBy Brian Platte / July 25, 2024 Which of the following statements about creditable prescription drug coverage is true? Creditable coverage is drug coverage that pays, on average, at least as much as Medicare’s standard drug coverage. Beneficiaries who have another source of creditable drug coverage may avoid Late Enrollment Penalties. Beneficiaries who maintain a source of creditable coverage may stay in that plan and are not required to enroll in Medicare Part D. All of the above statements are true. Which statement is NOT true about Low Income Assistance for Part D plans? Qualifications for low-income assistance are reviewed every 3 years It provides beneficiaries, with limited income and resources, financial assistance towards the cost of paying plan premiums and may assist with deductibles and co-payments The Social Security Administration offers 3 levels of low-income assistance based on Federal Poverty Level data Once a beneficiary qualifies for low-income assistance, they will receive “low income subsidy” until such time as they fail to meet the qualifications Which Part D benefit phase was eliminated starting with Calendar Year 2025? Catastrophic Coverage phase Initial Coverage phase Deductible phase Coverage Gap phase Members may have reduced cost-share amounts on certain formulary tiers when utilizing preferred pharmacies. True False Which choice does not represent a drug exception option? A tiering exception - when a member requests to obtain a Medicare covered prescription drug at a more favorable cost-sharing level A utilization restriction exception - when a member requests to obtain a Medicare covered prescription drug with prior authorization or quantity limits waived or set at a higher level A late enrollment exception - when a member requests to obtain a Medicare covered prescription drug outside of the standard election period timeframes A formulary exception - allowing a member to obtain a Medicare-covered prescription drug that is not on a plan’s formulary Agents do not need to confirm drug coverage with the beneficiary if they have specific medication concerns as all plan formularies cover the same drugs. True False Catastrophic Coverage begins once the member reaches the _____ threshold. Deductible Formulary Coverage gap TrOOP Which statement does not represent a Formulary Transition Requirement? Enrollees initially enrolling in Part D, must receive coverage of a single 30-day fill of their non-formulary drugs during the first 90 days after their enrollment Enrollees who reside in a long-term care facility (LTC) will be allowed to refill their prescription until we have provided them with a transition supply, consistent with dispensing increment. During the transition period, the Part D plan does not apply prior authorization or step therapy rules. All of the above represent a Formulary Transition Requirement Which of the statements below is true about the Deductible phase? Some plans may have a lower deductible or none at all Some plans may choose to limit the deductible to Brand Name drugs only The deductible is the amount a member must pay for their covered services before the Part D plan begins to pay All of the above statements are true Which of the following is not a condition for drugs covered under Part D? Approved by the Food and Drug Administration (FDA) Used and sold in the United States Used for any medically acceptable reason including off label use Available only by prescription ResultsVote
