Page 6 - Cover Letter and Evaluation for Craig Callan

For the Basaglar Kwikpen, I entered the annual quantity in order to get the most accurate
pricing. One package has five 3 ML pen, or 1,500 units of medicine. If you use 12 units a day, a
package lasts 125 days, or approximately four months. Because the Plan Finder does not have a
four-month refill option, I used the annual refill option and specified three packages. Let me
know if my calculations are wrong and I can re-run the drugs to get the most accurate pricing.
You can, of course, order the packages one at a time as you need them.

In all the options shown in the evaluation, your annual Rx drug costs are in the $7,000+ range.
The high cost is because Humalog and Savaysa are not on the formularies of any of the Part D
plans except the Kaiser Advantage plans. If they were, your annual costs would be trimmed by
more than $4,000. Plans usually charge the full retail price for non-formulary drugs, and these
costs do not count toward the plan’s deductible or catastrophic coverage limit.

One possible solution is to request formulary exceptions for these two drugs from the plan that
you enroll in. If the plan approves the exceptions, Medicare will pay about 75% of the cost for
these two drugs. When you request a formulary exception, your physician will need to justify
your need for these specific drugs as being medically necessary -- instead of similar drugs that
are on the plan’s formulary and that treat the same conditions. Medicare requires that Part D
plans have at least two formulary drugs in each therapeutic class.

Plans must respond to requests for formulary exceptions in a timely manner, usually within
three days. For life-saving drugs, expedited requests can be filed and must be responded to
within 24 hours. If your initial requests are denied, you have the right to appeal the decision.
And if your request is approved, the exception is made retroactive to the date of your request.
Appendix C4 includes explanations of how the formulary exception process works.

Another possible solution is that your physician says that one of the plan’s formulary drugs is
equally effective. If you want assistance in filing a request for a formulary exception, you may
be able to get no-cost help from Maryland’s State Health Insurance Assistance Program at (800)
243-3425 or the Medicare Rights Center at (800) 333-4114.

Finally, there are a couple of things to keep in mind as you make the transition to Medicare. On
your initial visits to your doctors, show the office staff your new enrollment cards. 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.

Sincerely,

David Armes, CFP®

Attachment to this letter: COBRA Rules

WDA:12115

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