Q1GROUP LLC
www.Q1Medicare.com

2013 Medicare Part D Plan’s Negotiated Retail Drug Price

Below you will find the average negotiated retail prescription drug price for your chosen Medicare Part D or Medicare Advantage plan, along with, tier cost-sharing details, your estimated cost for purchases during each coverage phase, tier cost-sharing details and your costs with explanations, and plan’s retail drug price history.
. .
Return to this plan’s 2013 Formulary Browser by choosing a letter below:
A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  0-9 
 
: : Go to CA’s 2013 Plan Page for plan materials
: : 2013 Plan Finder
: : Compare 2012 & 2013 Plans

Send this chart to my eMail!
Receive Part D Newsletter
      
2013 Medicare Part D Prescription Drug Price Information
Aetna Medicare Rx Premier (PDP) (S5810-202-0)
Enroll in Aetna Medicare Rx Premier (PDP).    
Monthly Plan Premium: $118.40   Deductible: $0   ICL: $2,970   Qualifies for LIS: No
PROLIA INJECTION  
Plan’s average negotiated retail drug price for a 30-Day
supply in CMS PDP Region 32, includes: CA
$873.38* 30-Day Supply

Formulary (Drug List) Drug Tier:Tier #4: Non-preferred brand

Gap Coverage:Many Generics and Some Brands

Drug Usage Management Restrictions:Prior Authorization and Quantity Limit:10/30Days

Formulary (Drug List) Tier Cost-Sharing Details
  30-Day Supply Cost-Sharing 90-Day Supply Cost-Sharing**
Prfrd. Pharm. Non- Prfrd. Mail- Order Prfrd. Pharm. Non- Prfrd. Mail- Order
This plan does not have an  
Initial Deductible:  
N/AN/AN/AN/AN/AN/A
Initial Coverage Phase  
Cost-Sharing:  
49% 49% 49% 49% 49% 49%
Donut Hole Phase Cost-Sharing:   100% 100% 100% 100% 100% 100%
Your Cost-Sharing could be the  
following if this medication is covered  
in the donut hole (or coverage gap).  
This information is not provided to us,  
so please contact this plan or consult  
this plan’s formulary to determine if  
this medication has gap coverage:  
49% 49% 49% 49% 49% 49%
Donut Hole Phase Discount (Brand):   47.5% 47.5% 47.5% 47.5% 47.5% 47.5%
Catastrophic Coverage Phase  
Cost-Sharing for Other Drugs  
(Brand-Name or Non-Preferred  
Multi-Source Drugs): 
The greater of 5% or $6.60 The greater of 5% or $6.60
Your Estimated Cost for Purchases During Each Coverage Phase (brands)
  30-Day Supply Cost-Sharing 90-Day Supply Cost-Sharing**
Prfrd. Pharm. Non- Prfrd. Mail- Order Prfrd. Pharm. Non- Prfrd. Mail- Order
Est. Cost Initial Coverage Phase:   $427.96 $427.96 $427.96 $1,283.87** $1,283.87** $1,283.87**
Your Est. Cost in Coverage Gap using  
the Brand-Name Drug Discount (52.5%):  
$414.85$414.85$414.85 $1,244.56$1,244.56$1,244.56
Your Estimated Cost in Catastrophic  
Coverage (Brand-Name or  
Non-Preferred Multi-Source Drugs):  
$43.67 $43.67 $43.67 $131.01 $131.01 $131.01
Tier Cost-Sharing Details and Your Costs with Explanations
  30-Day Supply Cost-Sharing 90-Day Supply Cost-Sharing**
Prfrd. Pharm. Non- Prfrd. Mail- Order Prfrd. Pharm. Non- Prfrd. Mail- Order
--- If you purchase during the Initial Deductible Phase ---
This plan does not have an  
Initial Deductible:  
N/AN/AN/AN/AN/AN/A
--- If you purchase during the Initial Coverage Phase ---
Initial Coverage Phase  
Cost-Sharing:  
49% 49% 49% 49% 49% 49%
Est. Cost Initial Coverage Phase:   $427.96 $427.96 $427.96 $1,283.87** $1,283.87** $1,283.87**
Explanation for 30-Day Preferred  
Pharmacy purchase:  
The cost-sharing for purchases made during the initial coverage phase (ICP) would be $427.96 or ($873.38 x 49%).
--- If you purchase during the Coverage Gap Phase (Donut Hole) ---
Donut Hole Phase Cost-Sharing:   100% 100% 100% 100% 100% 100%
Your Cost-Sharing could be the  
following if this medication is covered  
in the donut hole (or coverage gap).  
This information is not provided to us,  
so please contact this plan or consult  
this plan’s formulary to determine if  
this medication has gap coverage:  
49% 49% 49% 49% 49% 49%
Your Est. Cost in Coverage Gap using  
the Brand-Name Drug Discount (52.5%):  
$414.85$414.85$414.85 $1,244.56$1,244.56$1,244.56
Explanation for 30-Day Preferred  
Pharmacy purchase:  
The cost-sharing for purchases made during the coverage gap phase would be $873.38 or ($873.38 x 100%), then the brand-name drug discount is applied to your cost-sharing ($873.38 x 47.5% = $414.85) Your cost-sharing could be low if this medication is covered in the donut hole. We are not provided this information, so you will need to contact the plan or consult the plan’s formulary to determine if this drug has gap coverage.
--- If you purchase during the Catastrophic Coverage Phase ---
Catastrophic Coverage Phase  
Cost-Sharing for Other Drugs  
(Brand-Name or Non-Preferred  
Multi-Source Drugs): 
The greater of 5% or $6.60 The greater of 5% or $6.60
Your Estimated Cost in Catastrophic  
Coverage (Brand-Name or  
Non-Preferred Multi-Source Drugs):  
$43.67 $43.67 $43.67 $131.01 $131.01 $131.01
Explanation for 30-Day Preferred  
Pharmacy purchase:  
In the catastrophic coverage phase, you will pay the greater of 5% of the retail drug price or the minimum cost-share of $6.60. Calculating 5% of $873.38 = $43.67. Since $43.67 is more than $6.60, you would pay $43.67 for this drug at any pharmacy, because it is not a generic or preferred multi-source drug.

Aetna Medicare Rx Premier (PDP) Average Negotiated Retail Drug Price History
October, 2013: $873.38
January, 2013: $856.87
April, 2012: $858.08
September, 2010: N/A

*The plan’s Average Retail Drug Price is based on three things: (1) the medication, (2) the specific Medicare Part D plan, and (3) the pharmacies in the plan’s service area. In this case, the average of the PROLIA INJECTION prices that the Aetna Medicare Rx Premier (PDP) has negotiated with each of the retail pharmacies in the plan’s service area (in CMS PDP Region 32, includes: CA). In other words, when you use the Aetna Medicare Rx Premier (PDP) to purchase PROLIA INJECTION, you may pay slightly more or slightly less than the figures shown in the table above depending on the pharmacy where you fill your prescription.

**If the cost-sharing for your 90-day supply is a percentage (co-insurance), your estimated cost shown in the table above is calculated based on the 30-day average retail price multiplied by three (3). Please keep in mind that some plans offer discounts for purchasing a 90-day mail-order supply. For example, if you purchase a 90-day mail-order supply of your medication, you may only pay for a 60-day supply, based on your plan coverage. However, such a plan-specific discount is NOT shown in the table above because this data is not provided to us in a usable format. You can telephone the Medicare prescription drug plan directly for more details.
Return to this plan’s 2013 Formulary Browser by choosing a letter below:
A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  0-9 



What does all this mean? Here are a few notes to help you understand the above 2013 Medicare Part D Aetna Medicare Rx Premier (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the the standard $325 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons wit the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.

  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.

  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $2970) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2013 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).

  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.


(Chart Source: Centers for Medicare and Medicaid files: CMS Data October 2013 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.