Question

Mrs. Allen has a rare condition for which two different brand name drugs are the only available treatment. She is concerned that since no generic prescription drug is available and these drugs are very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either one of them. What should you tell her?

1) 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.
2) When medication costs exceed a certain threshold amount, which rises each year, a Medicare prescription drug plan is permitted to exclude coverage for all but the least expensive of the medications in a given category. Mrs. Allen will need to encourage her physician to prescribe the least expensive of the two alternatives.
3) Medicare prescription drug plans are required to include only a certain percentage of brand name drugs among those they cover. It may be possible that plans available in her area have opted not to include in their formularies the brand name drugs she needs. She may need to pay for this particular medication out of pocket.
4) Medicare prescription drug plans are allowed to restrict their coverage to generic drugs. She will need to pay for her brand name medications out of pocket.

Answer 1

Medicare prescription drug plans are required to cover drugs in each therapeutic category. Mrs. Allen should be able to find a plan that covers the medications she needs.

Step-by-step explanation:

The correct answer is 1) 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.

Under Medicare Part D, prescription drug plans are required to provide coverage for at least two drugs in each therapeutic category. This means that Mrs. Allen should be able to find a Medicare prescription drug plan that covers at least one of the two brand name drugs she needs for her rare condition.

It's worth noting that the availability and cost of specific medications may vary depending on the individual plan and its formulary, so Mrs. Allen should carefully review her options to ensure that the plan she chooses covers the specific drugs she needs.