Page 3 - Cover Letter and Medicare Evaluation for Diane Falten

Rx Drug Plan Coverage

The list of your Rx drugs, dosages, and monthly quantities is in Appendix C1. These are the Rx
drugs that I entered in Medicare’s Plan Finder program, which then identifies each plan’s costs
for your drugs. Armour Thyroid is not included because it’s not shown in the Medicare Plan
Finder program.

Even though Armour Thyroid is not listed, you can request a formulary exception. To do that,
your physician will need to submit a supporting statement as to why you need Armour Thyroid
instead of a substitute drug that the plan has on its formulary and that is used to treat the same
condition. Medicare’s explanation of the formulary exception is in Appendix C2.

In addition, even though all three plans include memantine hydrochloride in their formularies,
all three indicate that they may require a “prior authorization” from your physician before they
will cover this drug. The prior authorization process is similar to the formulary exception
process – your physician will probably have to submit a supporting statement explains why you
need this drug instead of a substitute drug that the plan may recommend.

CVS pharmacy is a preferred pharmacy in all three plans, which means you will probably get the
best pricing there. The Martin’s Point Generations Advantage Prime HMO-POS Plan has the
lowest costs for your drugs at $120 for 2022, while the Martins Point Generations Advantage
Flex Regional PPO Plan has the highest annual costs at $473.

Finally, when you begin your Advantage plan coverage, show your medical providers your
Advantage plan enrollment card on your initial visits after your coverage begins. And show your
pharmacist as well. Doing this will help avoid any billing confusion. You may also be entitled to a
free “Welcome to Medicare” physical, which you can mention to your primary care doctor.

Sincerely,

David Armes, CFP®

Appendices

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