Plan Finder Tool Casework
AA is a 77 year-old male Medicare beneficiary (with both parts of Original Medicare) who resides in Granada Hills, California (Zip Code: 91344). AA currently has WellCare Extra (PDP) through which he gets his prescription drug coverage. AA does not qualify for extra help.
AA’s monthly medications, unless otherwise noted, include:
Lyrica 50mg- one capsule three times a day
Furosemide 40mg-one tablet every morning
Metoprolol tartrate 25mg- one tablet twice daily
Olmesartan 20mg- one tablet daily
Hydrocodone/Acetaminophen 10/325- one tablet four times a day as needed for pain (he gets #60 every 2 months)
Livalo 1mg- one tablet daily
AA gets all of his medications from Knollwood Pharmacy on San Fernando Mission Blvd., but would also consider going to Walmart Pharmacy on Rinaldi (zip code: 91326) if he can save money by doing so.
1. What is the estimated annual retail cost (rest of 2017) that AA could be expected to pay under his current plan $______?
2. Are all of AA’s medications covered under his current (Wellcare Extra) plan? If ‘no’, which of his medications are not on formulary?
______
2b. If AA were to ask for a formulary exception, and it were granted, how much would AA pay for any non-formulary medications under his current plan during the initial coverage level?
______
3. What is the least expensive PDP [retail pharmacy] for the rest of 2017? Please record the plan name, ID # and Estimated Annual Cost (Retail) based on AA’s current medication regimen:
Plan Name: ______
Plan ID #: ______
EAC: $______
4. What is the potential cost savings for the rest of 2017 that AA could realize if he were able to switch from his current PDP to the lowest cost PDP today? ______
5. Under the lowest (retail pharmacy) cost PDP for the rest of 2017, what is the cost difference between AA’s two preferred pharmacies?
a. Knollwood: $______
b. Walmart: $______
c. Cost difference (a-b): $______
6. Given AA’s current situation, are there any Part D plans that he would be allowed to switch into today? If so, what are the names of those plans?
______