Date Emailed:
Due Date:
First Name: Last Name: Email:Case Study: Nomar Moola
Nomar comes to see you in the SHINE Office in November 2012 to review his drug plan options for 2013. He currently has AARP Medicare Rx Preferred PDP but is not sure if this plan is the most affordable option for 2013. He tells you the doctor is starting him on an expensive medication called Enbrel in January and he’s concerned this could put him in the donut hole. Nomar is single, 68 years old, receives no extra help, and has a monthly income of $2,100 and $20,000 in assets. He lives in zip code 02119 and uses Rite Aid Pharmacy.
Medication List (4):
Medicine Name
/ Quantity
/ Frequency & Pharmacy
/
Fosamax (uses generic) TAB 70MG / 4 TABS / Every 1 Month
Retail Pharmacy
Enbrel INJ 25MG / 4 X 1Box of 1 kits (sold in a package of 4 kits) / Every 1 Month
Retail Pharmacy
Humalog INJ 100/ML / 1 X10ML Vial / Every 1 Month
Retail Pharmacy
Ativan (uses generic) TAB 1MG / 60 TABS / Every 1 Month
Retail Pharmacy
Please provide your Drug ID: 7148305312 and Password Date: 9/14/2013
What is the annual retail cost of Nomar’s current plan in 2013? $3,795
- Does this plan have any drug restrictions? Yes, P. Auth on Enbrel
What drug plan offers the lowest annual retail costs in 2013? Humana-Walmart Preferred
- What is the annual retail cost? $3,615
- What is the cost of Enbrel in the Initial Coverage Period? $310.58
- What is the cost of Enbrel in the Coverage Gap? $590.10
If Nomar decided to use a mail order pharmacy what is the least expensive plan in 2013? His current plan, AARP Medicare Rx Preferred $3,685
Do all Medicare Prescription Drug Plans offer the option of using a mail order pharmacy? No
Does Nomar qualify for Extra Help and/or Prescription Advantage? Why or Why Not? Over income and asset for LIS, Will qualify for PA
If Nomar was approved for Prescription Advantage how would it help him? Provide Gap Coverage ($12/generic and $30 for brand name during donut hole, also limits out of pocket expenses)
If Nomar was a prescribed a new medication in the middle of the year, would he be allowed to change his drug plan? No