Page 4 - Cover Letter and Evaluation for Gary Caskey

will continue to get monthly refills at a CVS Pharmacy. That amount ($4,282) does reflect the
revised dosages, but the annual costs shown on page 4 of the evaluation do not.

The First Health Part D Value Plus Plan is the only plan in your area that has all your drugs in its
formulary. But the next lowest-cost plan – the Aetna Medicare Rx Select plan – does have
Nucynta in its formulary. It doesn’t, though, include one of your other drugs --
amlodipine/olmesartan. If you were to enroll in this plan, you would buy
amlodipine/olmesartan without insurance, in which case your annual costs would be roughly
equivalent to the First Health Part D Value Plus Plan.

Because your drug costs are relatively high, it’s important to identify the lowest-cost plan each
year during annual open enrollment and if it makes financial sense to do so, to switch plans. In
most cases your prescriptions will be transferred from your “old” plan to the new one. And you
do not need to dis-enroll from the old plan – when Medicare is notified that you have enrolled
in a different plan, it will dis-enroll you from your old plan at year’s end.

It’s possible that you will need new prescriptions from your physicians in whatever Part D plan
you choose, but first you might check to see if they can be transferred from your current plan.

Finally, there are a couple of things to keep in mind if you make the transition to Medicare as
your primary coverage. On your initial visits to your doctors after June 1, show the office staff
your enrollment cards for Medicare A&B, your Medigap policy and your Part D stand-alone
plan. That will help to avoid any billing confusion. Also, you’re entitled to a free “Welcome to
Medicare” physical (see page 11 of the evaluation), but you’ll probably have to request it.

Your Employer Plan

Because it is a high-deductible plan, your employer plan is ideally suited for people who use
relatively few medical services and take one or two generic drugs, at most. But it’s not a good
fit for people who take several drugs, see their doctors frequently, and have expensive tests
and treatments.

There’s not enough information in the plan summary documents to make a careful comparison
of costs, particularly for prescription drugs. In the employer plan the Rx drug costs do not have
a separate deductible but are subject to the plan’s $2,700 deductible, (the exceptions are drugs
that the plan considers to be preventive). Moreover, in the employer plan you’re paying
roughly $4,500 for a non-formulary drug. Plus, there’s some portion of your premium that goes
toward drug coverage.

Another concern is the high level of risk if you often use out-of-network services. Costs for
these services, which are 45% in most cases, appear to count only toward the $15,750 out-of-
pocket limit for an individual, whereas costs for in-network services are capped at $6,550.

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