Page 4 - Cover Letter and Medicare Evaluation for Heidi Bathon

One of your drugs – the diclofenac epolamine patches – will require a prior authorization by the
plan before it will be covered. In most cases, this means that your physician will need to write a
supporting justification of your need for this specific drug instead of a similar drug that’s used
to treat the same condition and that the plan has on its formulary. Prior authorizations are
common, and they are not always enforced, but in a worst case the plan might not cover these
patches.

In addition, the plan does not cover alprazolam at the amounts I entered, but it does cover it at
lesser amounts. Since you take this drug only as needed, this may not be a problem. If, for
example, you need a refill every four months instead of the two months that I entered, it may
be covered (or at six months). As with the prior authorization, you can request an exception if
necessary.

As mentioned, the AARP MedicareRx Preferred PDP is the lowest-cost plan for your drugs. Its
estimated annual costs, including premiums and co-payments, are $4,849.57 a year for mail-
order refills, and about $5,200 a year at a local pharmacy (the cost will vary by pharmacy, as
shown in Appendix C3).

This plan’s costs for your drugs are less than one-half as much as the next lowest-cost plan –
the Wellcare Value Script Plan – which as shown in Appendix C2 has an estimated annual cost
of more than $11,000. I also checked the Advantage plans in your county, all of which cost
more than $11,000 a year.

Switching to mail-order refills will save about $300 a year, but if you do switch you will need to
get new prescriptions from your doctors. And CVS is not a preferred pharmacy in the AARP
plan, so when you do need to get a prescription filled locally, you might save money by getting
it at Walgreens or Walmart.

Heidi, please let me know if you have any questions. There are a couple of things to keep in
mind as you make the transition to a Medigap policy and stand-alone drug plan. On your initial
visits to physicians after January 1, show the office staff your enrollment card for the Medigap
plan you’ve chosen. And on your first visit to the pharmacy after January 1, show the
pharmacist the enrollment card for the stand-alone drug plan you’re enrolled in.

Sincerely,

David Armes, CFP®

Attachment and Appendices
WDA:12431

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