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3 Day Medicare Part D Training

1

DAY ONE

Welcome and Introductions

Powerpoint

Overview of SHINE

Original Medicare (Part A & B)

Handout: 2013 Options for Supplementing Medicare Chart

Medicare Supplement Plans (Medigap)

Medicare Advantage Plans (Part C)

Other Sources of Supplementing Medicare

Medicare Part D

Handout: 2013 Medicare Part D Basic Structure Chart

Handout: 2013 Stand Alone Part D Drug Plans for Massachusetts

Explanation of Extra Help

Explanation of Prescription Advantage

Handout: Extra Help and Prescription Advantage Information and Eligibility Guide

Handout: Special Enrollment Periods

3 Day Medicare Part D Training

2

DAY TWO

Review Questions

Case Studies (Slides 39‐42 PPT)

Phil Harmonic

Bart Ender

Pat E. Cakes

Lucy and Ricky

Plan Finder Introduction

Watch Plan Finder Video http://www.medicare.gov/find‐a‐plan/staticpages/help.aspx

Handout: Medicare Plan Finder Guide and Preferred Pharmacies Chart

Medicare Plan Finder Demo using Medicare Plan Finder Guide and Exercise (Handout)

Plan Finder Case Study: (time permitting)

Sam Curious

Sam and his daughter Samantha visit you at the SHINE office. Sam has just been

approved for MassHealth and now needs to sign up for a Part D plan. Samantha is

concerned about her father paying a high premium and a penalty. How would you help

them?

Medlist: Aricept (generic) 10mg/day, Namenda 10mg 2/day, Lorazepam 1mg 2/day

Client Contact Form Review

Handout: Client Contact Form

Homework

Case Study: Mrs. Smith (Handout). Counselors should try to work through the exercise using the

Medicare Plan Finder Guide.

2013 Medicare Part D Basic Structure

The Part D Basic Structure is renewed each calendar year. The figures represented in this chart will be in effect until 12/31/2013.

Deductible

Initial Coverage Period (ICL)

Coverage Gap (Donut Hole)

Catastrophic

1st Phase requires member to pay the full cost of

drugs.* Not all drug plans have a deductible phase. *Some plans provide coverage for generics during the deductible

2nd Phase requires member to pay a fixed co‐pay or

co‐insurance.

3rd Phase begins when the retail value of drugs

purchased reaches $2,970. Member will pay higher

coinsurances for medications.

4th Phase begins when out of pocket spending reaches

$4,750.

The $4,750 represents everything the MEMBERPAID during Phases 1, 2, and 3 plus what the PLANPAID for brand names

during Phase 3

0‐$325 depending on plan

No more than 25% of the retail cost for generic and

brand

47.5% of retail cost for brand

79% of retail cost for generic

5% of retail cost for brand and generic

No more than $2.65 for generic

No more than $6.60 for brand

Nothing

75%

52.5% of retail cost for brand

21% of retail cost for generic

95%

4 Phases of Coverage Description Member Pays Plan Pays

Organization Name Plan Name 2013

PremiumPremium Change

After Full LIS

Plan Deductible

Prescription Copays # 30 Day Supply - Retail

Prescription Copays # 90 Day Supply - Mail Gap coverage

Aetna Medicare 1-877-238-6211 Aetna CVS/pharmacy (S5810-036) $31.60 $5.60 $0* $325 2 / 5 / 45 / 38% / 25% 5 / 15 / 135 / 38% / 25%

non-member 1-888-247-1028 Aetna Medicare Rx Premier(S5810-172) $109.60 $17.70 $78.20 $0 5 / 33 / 45 / 37% / 33% 5 / 99 / 135 / 37% / 33% many gen/some brandswww.aetnamedicare.com

Blue MedicareRx 1-888-543-4917 Blue Medicare Rx-Value Plus(S2893-001) $39.20 -$1.50 $7.80 $250** 6 / 12 / 45 / 95 / 26% 6 / 24 / 90 / 190non-member 1-866-832-9775 Blue Medicare Rx-Premier(S2893-003) $100.70 -$4.20 $69.30 $0 4 / 9 / 30 / 70 / 33% 4 / 18 / 60 / 140 many gen/few brands

www.rxmedicareplans.com

Cigna Medicare Rx 1-800-222-6700 CIGNA MedicareRx Plan 1 (S5617-008) $34.00 $3.40 $2.60 $325 0 / 8 / 35 / 85 / 25% 0 / 24 / 105 / 255 / 25%

non-member 1-800-735-1459 CIGNA MedicareRx Plan 2 (S5617-172) $76.50 $8.70 $45.10 $0 0 / 10 / 45 / 90 / 33% 0 / 30 / 135 / 270 / 33% few genwww.cignamedicarerx.com

Envision Rx Plus 1-866-250-2005 EnvisionRxPlus Silver (S7694-002) $33.20 -$0.20 $1.80 $325 25%

www.envisionrxplus.com EnvisionRxPlus Gold (S7694-073) $54.00 -$11.80 $22.60 $150 1% / 1% / 1% / 30% / 29% 1% / 1% / 1% / 30% some gen

Express Scripts Medicare 1-866-544-7086 Express Scripts Medicare Value (S5660-105) $47.80 $5.40 $16.40 $325 4 / 7 / 25% / 50% / 25% 12 / 21 / 25% 50%

www.medcomedicare.com

First Health Part D 1-800-882-3822 First Health Part D Premier (S5768-038) $34.90 $4.80 $3.50 $325 1 / 25% / 42%

www.firsthealthpartd.com First Health Part D Value Plus (S5768-126) $31.00 $5.20 $18.70 $0 0 / 35 / 70 / 33%

First Health Part D Premier Plus (S5674-011) $92.40 $0.20 $61.00 $0 0 / 20 / 25% / 41 / 33% some gen/some brand

HealthMarkets Medicare 1-888-625-5531 Reader's Digest Value Rx (S0128-004) $33.60 n/a $2.20 $325 1 / 2.50 / 39 / 27% 3 / 7.50 / 111 / 27%

www.hmic-medicare.comHealthSpring 1-800-331-6293 HealthSpring RX Drug Plan-Reg 2 (S5932-003) $37.70 $3.80 $6.30 $325 25% www.healthspring.com

Humana 1-800-281-6918 Humana Walmart-Preferred Rx Plan (S5884-102) $18.50 $3.40 $0 $325 1 / 4 / 20% / 30% / 25% 0 / 0 / 20% / 30%

non-member 1-800-706-0872 Humana Enhanced(S5884-002) $43.10 $4.20 $11.70 $0 2 / 5 / 44 / 90 / 33% 0 / 0 / 122 / 260www.humana-medicare.com Humana Complete(S5884-031) $114.00 $3.80 $82.60 $0 5 / 38 / 72 / 33% 0 / 104 / 206 some gen/some brand

SilverScript 1-866-235-5660 SilverScript Choice (S5601-111) $29.20 n/a $16.50 $0 0 / 34 / 35% / 33% 0 / 85 / 35% / 33%

non-member 1-866-552-6106 SilverScript Basic (S5601-004) $30.50 -$0.20 $0 $325 2 / 22% / 43% / 25% 5 / 22% / 43% / 25%www.silverscript.com SilverScript Plus(S5601-005) $102.90 $17.70 $71.50 $0 0 / 34 / 35% / 33% 0 / 85 / 35% / 33% many gen/some brand

SmartD Rx 1-855-976-2781 SmartD Rx Saver (S0064-002) $32.40 n/a $0* $325 0 / 20 / 35 / 85 / 25%

www.smartdrx.com SmartD Rx Plus (S0064-037) $69.00 n/a $37.60 $0 0 / 20 / 35 / 85 / 25% some gen

Unicare 1-800-928-6201 MedicareRx Rewards Standard (S5960-108) $52.50 $12.00 $21.10 $325 2 / 7 / 33 / 85 / 25% 3 / 10.50 / 82.50 / 212.50 / 25%

non-member 1-866-552-6106www.medicarerxrewards.com

United American 1-866-524-4169 United American Select (S5755-074) $33.70 $1.80 $2.30 $325 1 / 4 / 40 / 95 / 25% 0 / 24 / 122 / 257 / 25%www.uamedicarepartd.com United American Enhanced(S5755-006) $51.20 $6.00 $19.80 $140** 1 / 7 / 40 / 95 / 29% 0 / 30 / 90 / 190 / 29%

UnitedHealthcare 1-888-867-5575 AARP MedicareRx Saver Plus (S5921-348) $15.00 n/a $0 $325 1 / 2 / 25 / 45 / 25% 0 / 2 / 60 / 120 / 25%

non-member 1-888-867-5564 AARP MedicareRx Preferred(S5820-002) $37.70 $0.70 $6.30 $0 3 / 5 / 40 / 85 / 33% 0 / 5 / 105 / 240 / 33%www.partdcentral.com AARP MedicareRx Enhanced(S5921-183) $90.00 $4.70 $58.60 $0 2 / 5 / 40 / 76 / 33% 0 / 5 / 105 / 213 / 33% some gen/some brand

WellCare 1-888-550-5252 WellCare Classic(S5967-139) $30.80 -$2.90 $0 $0 6 / 44 / 94 / 33% 18 / 132 / 282non-member 1-888-293-5151 WellCare Extra (S5967-174) $39.00 n/a $24.40 $0 0 / 25% / 25% / 50% / 33% 0 / 25% / 25% / 50% many gen

www.wellcarepdp.com

**Tier 1 medications not subject to plan deductible. Most plans have 5 tiers: preferred generic / non-preferred generic / preferred brand / non-preferred brand / specialty Late enrollment penalty based on 2013 National Base Premium of $31.17

2013 Massachusetts Stand Alone Medicare Drug PlansInformation as of 10/02/2012

Highlighted plans have a premium below 2013 benchmark of $31.35 or * the plan is participating in di-minimus (reducing the premium up to $2 for individuals with full LIS/Extra Help) Plan copayments listed above are for preferred pharmacies. Copayments may be higher at other network pharmacies. Contact plan for more details.

MetroWest SHINE Program Revised 2/2013

Situation Your SEP is …

You belong to Prescription Advantage (a state pharmacy assistance program) or within the last 2 months lost participation in such a program.

One chance/year to join or switch your plan

You are eligible for Part D, even if you do not have a PDP or MA-PD now(5-Star SEP: December 8 through November 30 of the following year).

One chance/year to join or switch to 5-Star plan

You recently moved outside of the service area for your current plan.2 - 14 months based on notification to plan

Due to a move, you have new plan options, even if you did not already have a PDP or MA-PD (Medicare Advantage plan with prescription drug coverage).

Up to two months after move

You recently returned to the United States after living permanently outside of the U.S. or you were recently released from incarceration.

Up to 2 months AFTER you move (3 mos. if IEP)

You are moving out of a Long Term Care Facility.Up to 2 months AFTER you move out of facility

You just moved to or are currently living in a Long Term Care Facility (e.g. a nursing home).

Continuous monthly SEP

You have both Medicare & Medicaid (MassHealth Standard, PCA, Frail Elder, CommonHealth) or a Medicare Savings Program (Buy-ins: QMB, SLMB, QI-1).

Continuous monthly SEP

You are currently receiving "extra help" (LIS). Continuous monthly SEP

You are no longer eligible for "extra help" (LIS) during the calendar year.Up to 2 months AFTER you lose "extra help"

You are no longer eligible for "extra help" (LIS) at the end of the calendar year.January 1 - March 31 of following year

You recently involuntarily lost your creditable drug coverage. Up to 2 months AFTER you lose coverage

You are leaving coverage from your employer or union (including COBRA or Retiree coverage) SEP EGHP.

Up to 2 months AFTER you drop plan

In the last 12 months, you joined a MA-PD when you turned 65 (MA SEP 65). You may drop MA-PD and enroll in PDP

In the last 12 months, you left a Medigap policy to join a MA-PD for the first time.You may drop MA-PD and enroll in PDP

You have had Medicare prior to now, but are now turning 65.7 month IEP around 65th birthday

You have disenrolled from your MA plan during the MA disenrollment period (Jan 1 - Feb 14) regardless of whether you had drug coverage.

You may enroll in a PDP Jan 1 - Feb 14

In addition to the Initial Enrollment Period (IEP) for Medicare (7 months around beneficiary's 65th birthday) and the Annual Enrollment Period (October 15 - December 7 each year), there are several "special enrollment periods" (SEPs) when you may elect or change your current plan. If any of the statements below match your current situation, you may be eligible to join or switch your drug plan at this time. Note: Unless it is a 'continuous' SEP, the SEP ends when your enrollment in a new plan becomes effective or when the SEP time frame ends, whichever comes first. Most SEPS apply to PDPs and MA-PDs, except as noted .

PDP/MA-PD SEPs

Appendix G


Situation Your SEP is …

Your plan is not renewed for the next contract year.October 15 through last day of February

Your plan terminates its contract with Medicare during the contract year. Up to 1 month after contract ends (2 mos.if CMS terminates plan)

You recently left a Programs of All-inclusive Care for the Elderly (PACE) program. Up to 2 months AFTER you drop plan

You are being disenrolled from a Medicare special needs plan because you no longer have special needs status.

Up to 3 months AFTER disenrollment

You are disenrolling from a Medicare Cost plan and had Medicare prescription drug coverage from the Medicare Cost plan.

You may enroll in a PDP up to 2 months after

You are in a Medicare Cost plan that is not renewing its contract and had Medicare prescription drug coverage from the Medicare Cost plan.

Nov 1 of contract year - Jan 31 of following year

You were recently disenrolled from a MA-PD due to loss of Part B, but you still have Part A.

You may enroll in a PDP up to 2 months after

You are using the MA Open Enrollment Period for Institutionalized Individuals (OEPI) to disenroll from a MA-PD.

Up to 2 months after MA-PD disenrollment

CMS has determined your plan has violated its contract or you disenrolled due to a CMS sanction.

Determined by CMS

You were not adequately notified of your creditable drug coverage status.Up to 2 months after CMS approval

You were enrolled or not enrolled due to an error by a federal employee.Up to 2 months after CMS approval

You are a member of a low-performing plan. Contact 1-800-MEDICARE

You already had Part A and you enrolled in Part B during the the General Enrollment Period (January - March, effective July 1).

April 1 - June 30, effective July 1 (MA-PD only)

You do not qualify for premium-free Part A and you enrolled in Part B during the General Enrollment Period (January - March, effective July 1).

April 1 - June 30, effective July 1 (PDP only)

You have a PDP and are switching to a SNP (special needs plan). Anytime, if eligible for SNP

You are enrolling in a Chronic Care SNP (special needs plan), regardless of whether you already have a Part D plan.

Anytime, if eligible for SNP

You are disenrolling from a PDP or MA-PD to enroll in or maintain other creditable coverage (such as VA or TriCare).

Anytime

You have retroactively been enrolled in Medicare.Up to 3 months after month of notification

Other Determined by CMS

PDP/MA-PD SEPs (continued)

Appendix G

Limited Income Subsidy (LIS) “Extra Help”

Prescription Advantage (PA)

Funding Source Federal State

How to Apply Contact the Social Security Administration 1) Online application is easiest and available on

www.ssa.gov/extrahelp 2) Call 1‐800‐772‐1213 to apply by phone

Contact Prescription Advantage 1) Call 1‐800‐Age‐Info, Press option 2 to apply by

phone 2) Paper applications are available at your

counseling site

Are all Medicare beneficiaries eligible?

No, only beneficiaries who meet income and asset guidelines. There is no age restriction.

No, only beneficiaries residing in Massachusetts who meet income guidelines. There is no asset requirement. Income guidelines are different for individuals under 65 vs. over 65

Part D late enrollment penalty (LEP) paid?

Yes, Extra Help will pay any LEP for delayed Part D coverage while the beneficiary is eligible for Extra Help. If one loses Extra Help, penalty will apply.

No

Can someone receiving MassHealth benefits also qualify for this program?

Yes, beneficiaries who have Medicare and MassHealth will be given Full Extra Help benefits automatically.

No, beneficiaries on MassHealth are not eligible for Prescription Advantage.

Do I need to have a drug plan to apply for this program?

No, but upon approval Medicare will randomly assigned a beneficiary to a Part D plan if one not self‐selected.

No, but Prescription Advantage benefits will not work unless a member has a Part D plan or other drug coverage.

Is there a fee for coverage? No No, for most members. Members with higher incomes (above 500% FPL) have to pay an annual fee.

Special Enrollment Period (SEP)

Once per month Once per calendar year

Extra Help & Prescription Advantage Information Guide

Extra Help & Prescription Advantage Eligibility and Benefit Guide

Program Monthly Income

Limit Asset Limit

Premium Assistance

Deductible Assistance

Co‐pay Assistance

Out of pocket spending limit

Full Extra Help

$1,313 (single) $1,765 (couple)

$8,580 (single) $13,620 (couple)

Pays up to benchmark premium

Pays full deductible

$2.65/ generic $6.60/ brand (YEAR ROUND)

None

Partial Extra Help

$1,457 (single) $1,959 (couple)

$13,300 (single) $26,580 (couple)

Sliding scale assistance based on income

Lowers deductible to $66/year

15% coinsurance for generic and brand name (YEAR ROUND)

None

Prescription Advantage

On Medicare

and Over 65

$2,873* (single) $3,878* (couple) *Applicants with higher incomes may also be eligible for PA but would have to pay an annual membership fee.

NONE

No No Most members pay no more than: $12/ generic $30/ brand (IN COVERAGE GAP) Note: Members with lower incomes may pay less

Most members pay nothings for drugs after out of pocket costs reach $2,515* *Members will lower incomes may pay less

Prescription Advantage

On Medicare

and Under 65

$1,800 (single) $2,430 (couple)

NONE

No No Members pay no more than: $7/generic $18/brand (IN COVERAGE GAP) Note: Members with lower incomes may pay less

Member pays nothing for drugs after out of pocket costs reach $1,675* *Members will lower incomes may pay less

Full Extra Help…

Receive:

Full Premium Assistance

No Deductible

$2.65/generic, $6.60/brand

No donut hole

Partial Extra Help…

Receive:

Sliding Scale Premium Assistance

$66 Deductible

15% Coinsurance for generic and brand

No donut hole

Full Extra Help and Prescription Advantage…

Receive:

All benefits offered by Full Extra Help

Partial Extra Help and Prescription Advantage…

Receive all benefits offered by Partial Extra Help AND:

Pay no more than $7/generic and $18/brand all year

Pay nothing after co‐pays total $1,510

Prescription Advantage…

Over 65 Pays:

No more than $12/generic and $30/brand during donut hole*

Nothing after co‐pays total $2,515*

Under 65 Pays:

No more than $7/generic and $18/brand during donut hole*

Nothing after co‐pays total $1,675*

*Members with low incomes may pay less Note: Some members with incomes over 500% FPL only receive assistance after they

meet an out of pocket maximum and do not receive help during the donut hole.

If a Beneficiary Qualifies For…


Medicare Plan Finder Guide

A. Go to www.medicare.gov

B. Click “Find health & drug plans”, which is highlighted in yellow on the left side of the screen.

C. For a general search, enter zip code, then click “Find Plans”.

D. For a personalized search (recommended), enter zip code, Medicare number (no spaces), last name, effective date for Part A, date of birth, and then click “Find Plans”.

E. “Step 1 of 4: Enter Information” (general search only). Answer questions and click “Continue to Plan Results”.

F. “Step 2 of 4: Enter Your Drugs”. If a drug list was previously saved, enter the Drug List ID and Password Date, click “Retrieve My Drug List”, and go to letter “K” on this list. Note: For personalized searches, if a drug list was saved during a previous personalized search for this beneficiary, the saved drug list should appear automatically.

G. To begin drug list, type in drug name (or first few letters and click on drug name when it appears below). If the drug does not pop up, click “Find My Drug”; if a list is shown, click “+ Add Drug” next to the correct drug.

H. Adjust, if necessary, the dosage, quantity, frequency, and pharmacy type, and click “Add drug and dosage”.

I. If there is a lower cost generic available for a drug entered, another pop-up box will appear with the generic as a default, but it can be changed to the brand name. Then click “Continue”.

J. The drug list will automatically be saved with an ID and the current date as the password (which can be changed). Note: This is a good time to write this information down or print it.

K. The drugs will appear in a list below in alphabetical order. Continue to add/edit drugs. When list is complete, click “My Drug List is Complete”. The accuracy of the list is very important, so when in doubt, call the pharmacy. Note: To edit or add to the drug list at a later point in this search, click “Enter Your Drugs” near the top of all future pages.

L. “Step 3 of 4: Select Your Pharmacies”. Select at least one, but up to two pharmacies and then click “Continue to Plan Results”. Note: To find other pharmacies, increase the miles or click “Search New Location or by Pharmacy Name”.

M. “Step 4 of 4: Refine Your Results”. Select the types of plans (under “Summary of Your Search Results”) and then click “Continue to Plan Results”. Note: To see SCO and One Care plans (for duals), first click “Select Special Needs Plans” on left side of page, check the first box, and then click “Update Plan Results”.

N. “Your Plan Results”: The ten lowest cost plans (based on annual retail drug cost) will be listed for the selected plan types. To sort by a different category, select the category in the box above the plan list and then click on “Sort”. Note: The member’s current plan will appear first if a personalized search was done or if it was entered in a general search.

O. To view more plans, click on the desired number (e.g., “View 20”).

P. To view “Your Plan Details”, click on a plan name and view “Drug Costs & Coverage”.

Q. To view “Your Plan Comparison”, select up to 3 plans by checking the box in the first column on “Your Plan Results” page, click “Compare Plans”, and view “Drug Costs & Coverage”. Note: Any plan with an “i” in the first column cannot be selected to compare and does not show pricing data for the drugs entered.

R. To print or email the plan details and/or plan comparison, click “Print” or “Email” (at the top of the page, on the left). To customize a report, click “Print Plan Report” or “Print Comparison Report” under “Drug Coverage Information”.

S. To begin an online enrollment, click “Enroll” for the desired plan on the Plan Results, Details or Comparison page. Special Notes: Always look at the formulary restrictions. To view, click on “Yes” under “Drug Restrictions” column on “Your Plan

Results” page. Note: Actual QL amounts are shown in a separate table for most drugs. Beginning in October, plan data for the next year is displayed by default; the current year data can also be accessed.

Rev. 10/22/12

Preferred Pharmacies for 2013 Medicare Prescription Drug Plans

Many of the Medicare Prescription Drug Plans (PDP) for 2013 have preferred pharmacy pricing—meaning members will pay a reduced (or sometimes no) co‐payment for prescriptions filled at one of the plan’s preferred pharmacies. Below you will find the plans that have preferred pharmacy pricing, the corresponding preferred pharmacies, and breakdowns of how co‐payments differ between preferred and non‐preferred pharmacies. If a PDP is not listed below, it does not use preferred pharmacy pricing. When referencing SHINE’s Massachusetts Stand Alone Medicare Drug Plans chart, please note that the co‐payments given reflect the preferred pharmacy pricing if the plan has preferred pharmacies. All AARP Plans Preferred Pharmacies: Walgreens, Safeway, Kroger, Target, Stop and Shop, Publix, Hannaford, Wegmans

AARP MedicareRx Preferred Preferred Pharmacies

Other Network Pharmacies

Tier 1: Preferred Generic $3 $6

Tier 2: Non‐Preferred Generic $5 $10

Tier 3: Preferred Brand $40 $45

Tier 4: Non‐Preferred Brand $85 $95

Tier 5: Specialty 33% 33%

AARP MedicareRx Saver Plus Preferred Pharmacies







AARP MedicareRx Enhanced Preferred Pharmacies







Rev. 10/22/12

Aetna CVS/Pharmacy Preferred Pharmacies: CVS pharmacies

Aetna CVS/Pharmacy Preferred Pharmacies





Tier 4: Non‐Preferred Brand 38% 38%


EnvisionRx Plus Gold Preferred Pharmacies: COSTCO, Wal‐Mart, Walgreens, Stop and Shop, and some independent pharmacies

EnvisionRx Plus Gold Preferred Pharmacies


Tier 1: Preferred Generic 1% 25%

Tier 2: Non‐Preferred Generic 1% 25%

Tier 3: Preferred Brand 1% 25%



First Health Part D Preferred Pharmacies: Walgreens, Target, Wal‐Mart, KMART

First Health Part D Value Plus Preferred Pharmacies


Tier 1: Generic 0 7

Tier 2: Preferred Brand 35 45

Tier 3: Non‐Preferred Brand 70 95


Rev. 10/22/12

Humana Note: Each Humana Plan uses a different network of preferred pharmacies Humana Walmart Preferred Pharmacies: Walmart & Sam’s Club

Humana Walmart Preferred Preferred Pharmacies




Tier 3: Preferred Brand 20% 25%



Humana Enhanced Preferred Pharmacies: Walgreens, Wal‐Mart, Sam’s Club

Humana Enhanced Preferred Pharmacies

Other network pharmacies






Humana Complete Preferred Pharmacies: Most pharmacies

Humana Complete Preferred Pharmacies


Tier 1: Generic $5 $10




Rev. 10/22/12

SilverScript Preferred Pharmacies: CVS/pharmacy, Wal‐Mart, and select independent pharmacies

SilverScript Choice Preferred Pharmacies






SilverScript Plus Preferred Pharmacies






SmartD Rx Preferred Pharmacies: RxAlly alliance of independent pharmacies

SmartD Rx Saver Preferred Pharmacies







SmartD Rx Plus Preferred Pharmacies







Rev. 10/22/12

United American Preferred Pharmacies: CVS/pharmacy, Walmart, Sam’s Club, Kroger

United America Select Preferred Pharmacies







United America Enhanced Preferred Pharmacies







COSTCO

CVS/ pharmacy

Hannaford Kmart Kroger Publix Safeway Sam’s Club

Stop & Shop

Target Walgreens Walmart Wegmans

AARP MedicareRx Preferred

AARP MedicareRx Saver Plus

AARP MedicareRx Enhanced

Aetna CVS/pharmacy Envision Rx Plus Gold First Health Part D Value Plus

Humana Walmart Preferred

Humana Enhanced Humana Complete Most pharmacies

SilverScript Choice SilverScript Plus SmartD Rx Saver

Rx Ally alliance of independent pharmacies SmartD Rx Plus

United American Select

United American Enhanced

Medicare Plan Finder Case (Demo)

Go to the Medicare Plan Finder and do a general search for someone in zip code 02018. Assume the

person has Original Medicare, gets no extra help, and uses Walgreens pharmacy.

Enter the following drug list:

Lipitor (use the generic) 20mg 1/day

Advair Diskus 500/50 1 blister pack of 60/month

Answer the following:

1. What is the plan with the lowest annual retail drug cost?

2. What is the annual cost of this plan?

3. Does this plan have any restrictions?

4. What are the co‐pays for the two drugs when the initial coverage level is reached?

5. Does this person go into the “donut hole”?

ANSWER KEY

1. Well Care Classic

2. $1,515

3. Yes (QL’s)

4. Advair $44/month, Atorvastatin $6/mo

5. Yes, in August

Advair Diskus AER

500/50 Yes

1 package of 60 blister packs (60 blister packs total)

Every 30 Day(s)

Atorvastatin Calcium TAB 20MG

Yes 31 TABS Every 31 Day(s)

Medicare Plan Finder Demo

Go to the Medicare Plan Finder and do a general search for someone in zip code 02018. Assume the

person has Original Medicare, gets no extra help, and uses Walgreens pharmacy.

Enter the following drug list:

Lipitor (use the generic) 20mg 1/day

Advair Diskus 500/50 1 blister pack of 60/month

Answer the following:

1. What is the plan with the lowest annual retail drug cost?

2. What is the annual cost of this plan?

3. Does this plan have any restrictions?

4. What are the co‐pays for the two drugs when the initial coverage level is reached?

5. Does this person go into the “donut hole”?

Mrs. Smith comes to SHINE in November 2012 for help selecting a Medicare drug plan for 2013. Mrs. Smith is in Blue

Medicare Rx Value Plus PDP in 2012. She prefers CVS Pharmacy, lives in the zip code 02130, has Original Medicare,

gets no extra help, and takes the following prescriptions.

Medication List:

Zocor (takes generic) 40mg, 1x/day Celexa (takes generic) 10mg, 1x/day

Methotrexate Sodium 2.5mg, 24/month Gabapentin 300mg, 2x/day

Amiodarone 200mg, 1x/day Levetiracetam 500mg, 2x/day

Please enter the above information into the Medicare Plan Finder and then answer the following:

Drug List ID:__________________ Password Date:______________

1) What is the lowest annual retail cost plan using CVS pharmacy and what is the annual retail cost?

2) What is the cost of Amiodarone in the initial coverage level? Is there a deductible? (Answer this question based on the plan you selected for Question 1.)

3) What is the annual retail cost of the Blue Medicare Rx Value Plus Plan? Are there any drug restrictions with this plan?

4) If she wanted to go to Walgreens Pharmacy, what is the lowest annual retail cost drug plan and what does is cost?

For the remaining questions, assume Mrs. Smith is now on both Medicare and MassHealth.

5) Which PDP would you recommend for her in 2013? What is the monthly premium for this plan?

6) What is the lowest cost plan if she wants to use a mail order pharmacy?

Mrs. Smith comes to SHINE in November 2012 for help selecting a Medicare drug plan for 2013. Mrs. Smith is in Blue

Medicare Rx Value Plus PDP in 2012. She prefers CVS Pharmacy, lives in the zip code 02130, has Original Medicare,

gets no extra help, and takes the following prescriptions.

Medication List:

Zocor (takes generic) 40mg, 1x/day Celexa (takes generic) 10mg, 1x/day

Methotrexate Sodium 2.5mg, 24/month Gabapentin 300mg, 2x/day

Amiodarone 200mg, 1x/day Levetiracetam 500mg, 2x/day

Please enter the above information into the Medicare Plan Finder and then answer the following:

1) What is the lowest annual retail cost plan using CVS pharmacy and what is the annual retail cost?

WellCare Extra . Annual retail cost is $468

2) What is the cost of Amiodarone in the initial coverage level? Is there a deductible? Answer this question based on the plan you selected for Question 1.

$0 Copay during Initial coverage level.

There is no deductible with the Wellcare Extra Plan.

3) What is the annual retail cost of the Blue Medicare Rx Value Plus Plan? Are there any drug restrictions with this plan?

$1075 annual retail cost with Blue Medicare Rx Value Plus plan.

Yes Quantity Limits on Gabapentin 360 TABS per month, Celexa (Citalopram) 45 TABS per month, and Zocor (Simvastatin) 30 TABS per month. Quantity Limits are not affecting Mrs. Smith’s current dosage.

4) If she wanted to go to Walgreens Pharmacy, what is the lowest annual retail cost drug plan and what does is cost?

First Health Part D Value Plus. $372 annual retail cost.

For the remaining 2 questions, assume Mrs. Smith is now on both Medicare and MassHealth

5) Which PDP would you recommend for her in 2013? What is the monthly premium for this plan? Two plans are tied for lowest annual retail cost. First Health Part D Premier, $3.50/mo premium (1 QL on Levitiracetam allows 6/day) AARP Rx Saver Plus, $0/mo premium (No QL’s)

6) What is the lowest cost plan if she wants to use a mail order pharmacy?

Wellcare Classic offers $0/month co‐pays when using mail order pharmacy. Plan also has a $0 premium because Full Extra Help (LIS) is subsidizing the entire premium.

3 day medicare part d training - typepadumassmed.typepad.com/files/part-d-day-1-and-2... · 3 day...

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