Question

Which of these statements is NOT true about the drug utilization management (UM) rules?

Answer 1

Step treatment and the prior authorization quantity limit are two instances of the coverage rules.

What is drug utilization management (UM) rules?

The following are utilization management restrictions that your Medicare Part D (PDP) or Medicare Advantage plan (MAPD) may impose on your prescription medications: Limiting the amount of a specific medication you can receive in a set period of time.

Prior Authorization is the practice of forcing plan participants to get plan approval prior to filling a prescription.

Step Therapy is the practice of requiring plan participants to first try less expensive drugs (such generics) before switching to a more expensive one (usually a brand-name drug).

Any formulary drug offered by your Medicare drug plan may be subject to utilization management restrictions, and this list may change from year to year. If you continue to use the same drug plan the following year, you may discover that some of your formulary medications now fall under this category.

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