Page 6 - Cover letter & Medicare evaluation for Mr. Carl Zambon

In Appendix D1, the pages that follow the list of Rx drugs you take are the stand-alone plans
that have the lowest costs for your drugs next year. The two lowest-cost plans are both
sponsored by Cigna, and to enroll in either of these plans, call (800) 735-1459.

If you want to get monthly refills at a retail pharmacy, the lowest-cost plan is the Cigna Secure-
Essential Rx Prescription Drug Plan (PDP), which has an estimated annual cost of $2,132 if you
get your prescriptions filled at a Walmart pharmacy. Or if you prefer to use mail order for your
prescriptions, next year’s lowest-cost plan is another Cigna plan – the Cigna Secure Rx Plan. It
will cost an estimated $1,928 for your drugs in 2021 -- the lowest cost of any option.

Both plans’ costs at various local pharmacies are shown on page 4 of your evaluation. Rite Aid is
not a preferred pharmacy in either of these plans, and when you get prescriptions filled at a
local pharmacy you will often get the lowest prices a plan’s preferred pharmacies. See if you
can get your current prescriptions transferred to your new plan at year’s end. If that can’t be
done, you’ll need to ask your doctors for new prescriptions.

The drug Praluent is not covered in either of these plans. When you enroll in a stand-alone plan,
you can request that Praluent be covered as a “formulary exception.” Usually your physician
will need to write a letter justifying your need for Praluent instead of another drug that is on
the plan’s formulary and that is used to treat the same condition.

If your request to have Praluent covered is denied, you can appeal. There’s no guarantee, of
course, that your request for a formulary exception will be approved, but it’s worth a try. You
can request the exception as soon as you are enrolled in a plan, even though it may be a few
weeks until your coverage begins. See the attachment to this letter for more information.

If your formulary exception request is ultimately denied, then you should purchase Praluent
without insurance at the lowest price you can find. You can buy it through the plan, of course,
but any money you spend for a non-covered drug will not count toward the plan’s deductible or
its different coverage phases. If you can get Praluent at a good price in your current employer
plan, you might consider getting a refill during March when your employer plan is still in effect.

Finally. Carl, there are a couple of things to keep in mind as you make the transition to your
new supplemental coverage. On your initial visits to your doctors after your Part B coverage
starts, show the office staff your Medigap enrollment card. That will help to avoid any billing
confusion. And show the enrollment card for your stand-alone drug plan to your pharmacist.

Sincerely,

David Armes, CFP®

Attachment: Explanation of formulary appeals
Appendices

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