AHIP Fraud, Waste, and Abuse (FWA) Practice Exam

Question: 1 / 400

How does Medicare ensure coverage for specialized medications in therapeutic categories?

All Medicare plans must cover these drugs without exceptions.

Beneficiaries must select plans specific to their rare conditions.

Medicare prescription drug plans are required to cover drugs in each therapeutic category.

The correct choice highlights a fundamental aspect of Medicare's approach to ensuring access to necessary medications. Medicare prescription drug plans, known as Part D plans, are mandated by law to offer coverage for a range of medications classified under various therapeutic categories. This requirement ensures that beneficiaries have access to essential medications for treating a variety of health conditions, facilitating better health outcomes.

By requiring coverage for drugs in each therapeutic category, Medicare provides beneficiaries with broader options and access to treatments that are critical for managing their health. This coverage is particularly important for individuals with chronic conditions or complex health needs, as it helps prevent interruptions in necessary therapy and supports continuity of care.

The other choices do not accurately reflect Medicare's policies. For example, not all Medicare plans must cover every specialized medication without exceptions, as there are specific formularies and possible step therapy requirements. Selecting plans specific to rare conditions may not reflect the comprehensive nature of Medicare coverage options as not all plans are tailored to such uniqueness. Finally, while no specific drug categories are mandated under Medicare as a whole designation, the requirement for coverage in therapeutic categories affirms that there is structured oversight in place.

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No specific drug categories are mandated under Medicare.

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