Question

Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition to drugs on his plan’s formulary he takes several other medications. These include a prescription drug not on his plan’s formulary, over-the-counter medications for colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP and he asks you if any of his other medications could count toward TrOOP should he ever reach the Part D catastrophic limit. What should you say?

Answer 1

The thing that I will say is that none of the costs of the other medications would currently count toward TrOOP but he can ask his plan for an exception in order to cover the prescription not on its formulary. This is related to Medicare.

What is Medicare?

It should be noted that Medicare is a government health insurance program in the United States that subsidizes healthcare services.

One of the clients and a recently registered Medicare Part D beneficiary is Mr. Wingate and also uses a number of additional medications not listed on the formulary of his insurance plan that include include a prescription pill that isn't covered by his plan's formulary, over-the-counter meds for colds and allergies, vitamins, and medications.

It should be noted that he'll have to ask his plan in order to get the requirements.

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