QuestionAugust 4, 2025

Mrs. Duran is enrolled in a prescription drug plan. She has heard about something called True-Out-Pocket costs or "TrOOP" and asks you if any of the following count toward reaching the catastrophic coverage phase. What do you say? 1. Her annual PDP deductible II. Supplemental coverage provided by an employer group waiver plan III. The off formulary drug her doctor prescribed but she pays for because the plan denied her exception request IV. Her over-the-counter (OTC) allergy medication. a. I only b. I,II, III, and IV C. I,II, and IV only d. Iand II only

Mrs. Duran is enrolled in a prescription drug plan. She has heard about something called True-Out-Pocket costs or "TrOOP" and asks you if any of the following count toward reaching the catastrophic coverage phase. What do you say? 1. Her annual PDP deductible II. Supplemental coverage provided by an employer group waiver plan III. The off formulary drug her doctor prescribed but she pays for because the plan denied her exception request IV. Her over-the-counter (OTC) allergy medication. a. I only b. I,II, III, and IV C. I,II, and IV only d. Iand II only
Mrs. Duran is enrolled in a prescription drug plan. She has heard about something called True-Out-Pocket costs or "TrOOP" and asks you if any of the following count toward reaching the catastrophic coverage phase. What do you say? 1. Her annual PDP deductible II. Supplemental coverage provided by an employer group waiver plan III. The off formulary drug her doctor prescribed but she pays for because the plan denied her exception request IV. Her over-the-counter (OTC) allergy medication. a. I only b. I,II, III, and IV C. I,II, and IV only d. Iand II only

Solution
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Answer

a. I only Explanation 1. Identify TrOOP Eligible Costs TrOOP costs include expenses that count towards reaching the catastrophic coverage phase in a prescription drug plan. These typically include the annual deductible, coinsurance, and copayments for covered drugs. 2. Evaluate Each Option I. Her annual PDP deductible - Counts towards TrOOP. II. Supplemental coverage provided by an employer group waiver plan - Does not count towards TrOOP. III. The off formulary drug her doctor prescribed but she pays for because the plan denied her exception request - Does not count towards TrOOP. IV. Her over-the-counter (OTC) allergy medication - Does not count towards TrOOP.

Explanation

1. Identify TrOOP Eligible Costs<br /> TrOOP costs include expenses that count towards reaching the catastrophic coverage phase in a prescription drug plan. These typically include the annual deductible, coinsurance, and copayments for covered drugs.<br /><br />2. Evaluate Each Option<br /> I. Her annual PDP deductible - Counts towards TrOOP.<br /> II. Supplemental coverage provided by an employer group waiver plan - Does not count towards TrOOP.<br /> III. The off formulary drug her doctor prescribed but she pays for because the plan denied her exception request - Does not count towards TrOOP.<br /> IV. Her over-the-counter (OTC) allergy medication - Does not count towards TrOOP.
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