Page 5 - Cover Letter and Evaluation for Raquelle Myers

year are $4,671 – premiums, deductible, and co-payments. If you get your prescriptions at
Olympic Pharmacy, estimated costs for the last five months of this year are $4,035.

Although mail-order initially appears to be more expensive, the cost difference between getting
your prescriptions filled by mail-order vs. Olympic Pharmacy is small. The reason that mail-
order appears to cost more is that if you were to order all your drugs by mail order on August 1
and again on November 1, as the Plan Finder assumes, you would still have a month’s supply
left at the end of this year. If you adjust the cost difference to account for that extra one
month’s supply, then the costs at Olympic Pharmacy and for mail order are roughly the same.

To enroll in the Cigna-HealthSpring Rx Secure Essential Prescription Drug Plan, call the plan’s
toll-free number at (800) 735-1459. This plan’s benefit summary is in Appendix D3 and the
other Cigna-HealthSpring plan’s benefit summary is in Appendix D4. These appendices show
your costs for each month starting in July you won’t begin your coverage until August 1).

The four drugs listed below are in some plan formularies, but not in the Cigna-HealthSpring
formularies. Since they are not in the formularies and thus not covered by the plan, you will pay
full price or perhaps more for these drugs if you buy them through the plan. These full-price
costs are included in the $4,671 estimate. The four drugs are:

1) Albuterol sulfate hfa (90 base) mcg/act aerosol solution
2) Budesonidate/formoterol 160-4.5 mcg/act aerosol (generic for Symbicort)
3) Insulin aspart, human 100 unit/ml solution (generic for NovoLog)
4) Insulin aspart, human 100 unit/ml pen injector (generic for NovoLog)

One option is to request from Cigna-HealthSpring (after you are enrolled in the plan) that you
be granted a formulary exception for one or more drugs as well as for the Omnipod system,
Novofine, and BD Syringes. An attachment to this letter explains how to request a formulary
exception, which will involve your physician(s) justifying your need for specific drugs – possibly
instead of substitute drugs that the plan has on its formulary. As an example, the Cigna-
HealthSpring plan does not cover Novolog, but it may cover a different brand of insulin, and
your physician would need to say that you need Novolog instead of the other brand of insulin.

If you decide to request one or more formulary exceptions and would like some assistance, you
might try contacting the Washington state’s SHIBA program – the Statewide Health Insurance
Benefits Advisors – at (800) 562-6900. In the past I have called SHIBA for questions about
Washington state’s coverage rules, and I have found them to be responsive and knowledgeable.
They might help to guide you through the process of requesting a formulary exception. SHIBA is
a Medicare and state-sponsored counseling agency that provides free advice.

But if you cannot get a formulary exception for a drug, you should shop around for the lowest
price for that drug. There is no benefit to buying non-formulary drugs through the plan because
any money you spend will not count toward Part D’s coverage limits.

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