Question

Mrs. Cantwell is enrolled in a prescription drug plan and asks about reaching the catastrophic coverage phase. Which of the following expenses count toward reaching the catastrophic coverage phase in her plan?

a) Only her annual PDP deductible
b) Drug manufacturer's discount for brand name drugs after the initial coverage period
c) Off-formulary drugs prescribed but denied by the plan
d) Over-the-counter (OTC) allergy medication

Answer 1

Only the annual PDP deductible, drug manufacturer's discount for brand name drugs after the initial coverage period, and off-formulary drugs prescribed but denied by the plan count toward reaching the catastrophic coverage phase.

Step-by-step explanation:

The expenses that count toward reaching the catastrophic coverage phase in Mrs. Cantwell's prescription drug plan are:

1. Only her annual PDP deductible: This is the amount she needs to pay out-of-pocket before her insurance starts covering the rest of the drug costs.
2. Drug manufacturer's discount for brand name drugs after the initial coverage period: This discount helps lower the costs of brand name drugs, making it easier for Mrs. Cantwell to reach the catastrophic coverage phase.
3. Off-formulary drugs prescribed but denied by the plan: Although they are denied by the plan, the costs of these drugs count towards the catastrophic coverage phase.