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Your Medicare prescription drug coverage as a member of
Medco Medicare Prescription Plan® for Tennessee Val ey Authority (TVA)
This mailing gives you the details about your Medicare prescription drug coverage from
January 1 – December 31, 2009, and explains how to get the prescription drugs you need.
This is an important legal document. Please keep it in a safe place.
Medco Medicare Prescription Plan Customer Service:
For help or information, please call Customer Service or go to our plan website at www.medco.com.
Calls to this number are free:
1-800-592-4520
TTY/TDD users call: 1-800-716-3231
Hours of Operation:
Our business hours are 24 hours a day, 7 days a week (except Thanksgiving and Christmas).
Customer Service is available in English and other languages.
This Plan is offered by Medco Containment Life Insurance Company and Medco Containment
Insurance Company of New York, referred to throughout the EOC as “we,” “us,” or “our.”
Medco Medicare Prescription Plan
is referred to as “Plan” or “our Plan.” Our organization
contracts with the Federal government.
This information may be available in a different format, including Spanish and braille. Please call
Customer Service at the numbers listed above if you need plan information in another format
or language.
Esta información puede estar disponible en otros idiomas u otros formatos, incluyendo una versión
en español y una versión en braille. Póngase en contacto con el departamento de Atención al cliente
marcando los números que se indican arriba, si necesita recibir la información del plan en otro formato
u otro idioma.
Important Information
How your plan wil change for 2009
This is the time of year when we like to thank you for your membership and let you know of new plan
changes for the upcoming year. Beginning January 1, 2009, there will be some changes to our Plan.
You are enrolled in Medco Medicare Prescription Plan for Tennessee Valley Authority (TVA) in 2008
and your plan coverage and costs are changing. All changes will be effective January 1, 2009.
This is just a brief summary of the changes in your Plan for 2009. Make sure to read the next few pages
for answers to important questions you may be asking.
If you have any questions, call Customer
Service. Note: If you are receiving help from your state Medicaid agency or State Pharmaceutical
Assistance Program (SPAP), such as a reduced co-payment, these reductions are not reflected in this
packet. Please call your state SPAP at the numbers listed in Section 8 if you have questions.
Changes to your monthly plan premium
Your monthly premium for your Medicare Supplement plan includes the Medicare Part D prescription
benefit as well as medical coverage. TVA will send you a letter in late October with your 2009 Medicare
Supplement premium.
This monthly premium amount does not include any late enrollment penalty you may be responsible for paying (see Section 1 in the Evidence of Coverage (EOC) for more information).
Changes to Your Part D Prescription Drug Benefits
Deductible
No change for 2009
Initial Coverage Limit
(total medication costs paid by
Tier 1 co-payments for
$10.00 co-payment for a
No change for 2009
generic drugs
one-month (30-day) supply at
a retail network pharmacy
$30.00 co-payment for a
three-month (90-day) supply at
a retail network pharmacy
$20.00 co-payment for a
three-month (90-day) supply
from our mail-order pharmacy

Tier 2 co-payments for
$30.00 co-payment for a
No change for 2009
preferred brand-name
one-month (30-day) supply at
a retail network pharmacy
$90.00 co-payment for a
three-month (90-day) supply at
a retail network pharmacy
$60.00 co-payment for a
three-month (90-day) supply
from our mail-order pharmacy

Tier 3 co-payments
$50.00 co-payment for a
No change for 2009
for non-preferred
one-month (30-day) supply at
brand-name drugs
a retail network pharmacy
$150.00 co-payment for a
three-month (90-day) supply at
a retail network pharmacy
$100.00 co-payment for a
three-month (90-day) supply
from our mail-order pharmacy

Tier 4 co-payments for
$50.00 co-payment for a
No change for 2009
specialty drugs
one-month (30-day) supply at
a retail network pharmacy
$150.00 co-payment for a
three-month (90-day) supply at
a retail network pharmacy
$100.00 co-payment for a
three-month (90-day) supply
from our mail-order pharmacy

Catastrophic Coverage
After your true out-of-pocket
After your true out-of-pocket
costs reach $4,050, you are
costs reach $4,350, you are
eligible for coverage as
eligible for coverage as
detailed by the chart below.
detailed by the chart below.
Generic drugs
Greater of $2.25 for generics
Greater of $2.40 for generics
or drugs treated as generics or
or drugs treated as generics or
5% coinsurance
5% coinsurance
Brand-name drugs
Greater of $5.60 or
Greater of $6.00 or
5% coinsurance
5% coinsurance
Prior Authorization
Prior authorization is now required for the following drugs for the 2009 plan year:
LIDODERM
Drug Tier Changes From 2008 to 2009
2008 Tier
2009 Tier
2008 Tier
2009 Tier
BARACLUDE
CEFOXITIN
COMBIVIR
DIBENZYLINE
EFFEXOR XR
EPIRUBICIN HCL
SOLUTION
MATULANE
CARBONATE
METOPROLOL
TARTRATE
NIMODIPINE
NORDITROPIN
CARTRIDGE
NORDITROPIN
OXSORALEN
NORDIFLEX PEN
PEG-INTRON
2008 Tier
2009 Tier
2008 Tier
2009 Tier
PEG-INTRON
PEG-INTRON
REDIPEN PAK 4
RIBASPHERE
RIBAVIRIN
TRIZIVIR
VIRACEPT
Drugs That Have Been Removed From Our Formulary for the 2009 Plan Year
ALPHATREX
AMITRIPTYLINE/
CHLORDIAZEPOXIDE
BD ECLIPSE SYRINGE/
1ML/30GX1/2"
BD NEEDLE/30G X 1/2"
CAMPTOSAR
CARNITOR
CLARINEX
CLARINEX REDITABS
CLARINEX-D 12 HOUR
CLARINEX-D 24 HOUR
DEPO-TESTOSTERONE
DEXASPORIN
DEXTROSE 2.5%
DIFLUCAN IN NACL
DIPROLENE
DYNABAC D5-PAK
ESTRADIOL/
ETH-OXYDOSE
NORETHINDRONE
FLOXIN OTIC
FLOXURIDINE
FLUOR-OP
FOSAMAX PLUS D
GENERLAC
KETOTIFEN FUMARATE
LAMICTAL
LIPOSYN III
LOPROX SHAMPOO
METHERGINE
NITRO-BID
NYSTATIN VAGINAL
OCUSULF-10
OPIUM TINCTURE
ORAMORPH SR
PAREGORIC
PHOSPHOLINE IODIDE
PLENAXIS
PROCTO-KIT
PULMICORT
RESERPINE
RISPERDAL
ROCALTROL
STROMECTOL
SULFACETAMIDE
SURMONTIL
TRILEPTAL
VOLTAREN
With this notice, you also received a 2009 Evidence of Coverage and a new formulary that will be
effective January 1, 2009. Medicare has reviewed and approved the covered drugs listed in the formulary.
Please see Section 10 for more information about the drug coverage described in the table above.

This is your Annual Notice of Change
Why am I receiving this information?
We are sending this Annual Notice of Change (ANOC) so you can review the 2009 coverage offered
through this Plan. Each year from November 15 through December 31, you may make a change to your
Medicare plan and Medicare prescription drug coverage, with your new plan beginning on January 1.
Certain individuals, such as those with Medicaid, those who get extra help, or who move, can make
changes at other times. If you want to stay in our Plan, you don’t need to do anything. You will still
be a member of our Plan for the coming year.

Note: If you are a member of a State Pharmaceutical Assistance Program (SPAP) or an employer group,
you may be required to belong to a specific plan in order to continue to get the additional benefits you
may be receiving. Please check with your SPAP or employer before switching to another prescription
drug program. The phone numbers for your SPAP can be found in Section 8 of the Evidence of Coverage.

_________________________________________________________________________________________
What if my drugs are not on the formulary or are in a more expensive
cost-sharing tier?

We have changed our formulary. The new formulary may be different from the one you are using. We
have added, removed, or placed more limitations on some of the drugs we cover. Please review the
formulary to see if we still cover the drugs that you currently take. To get a complete listing of all the
drugs we cover, you may visit our website or call Customer Service.

If a drug we currently cover for you is not on our new formulary, you will need to talk to your doctor
about taking an alternative drug that is available on our new formulary. If you wish to continue coverage
of your current drug, you or your doctor can request a formulary exception on or after January 1.
Beginning January 1, you will get a temporary supply of the drug we currently cover for you that is not
on our new formulary. You will need to talk to your doctor about switching to a covered drug, or request
a formulary exception before your temporary supply runs out. If a drug we currently cover for you is
on our new formulary but has been moved to a higher non-preferred cost-sharing tier, you can talk with
your doctor about taking an alternative drug that is available in a lower cost-sharing tier. If you wish to
pay the lower preferred cost-sharing amount for your current drug, you or your doctor can request
a tiering exception on or after January 1. Please refer to Section 5 in the Evidence of Coverage for
instructions on how to file an exception.

_________________________________________________________________________________________
What do I need to know if I qualify for extra help (the low-income subsidy,
or LIS) from Medicare to pay for my prescription drugs?

If you do qualify for extra help, a copy of your “Evidence of Coverage Rider for Those Who Receive
Extra Help Paying for Their Prescription Drugs” is enclosed in this package. The “Evidence of
Coverage Rider for Those Who Receive Extra Help Paying for Their Prescription Drugs” has
more specific information on your premiums and cost-sharing in 2009. Read this important information
carefully. If you don’t know what level of extra help you qualify for, you can call 1-800-MEDICARE
(1-800-633-4227). TTY users should call 1-877-486-2048.

Where can I get more information?
The Evidence of Coverage on the following pages has more information on our plan’s coverage,
including information on how to make changes to your membership in Section 6.

Please call Customer Service if you have any questions. You can also get information about the
Medicare program and other Medicare plans available by visiting www.medicare.gov or by calling
1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY/TDD users should call
1-877-486-2048.

Medco Health Solutions, Inc., 100 Parsons Pond Drive, Franklin Lakes, NJ 07417
Medco is a registered trademark of Medco Health Solutions, Inc.
Medco Medicare Prescription Plan is a registered trademark of Medco Health Solutions, Inc.

2008 Medco Health Solutions, Inc. All rights reserved.
LT917320

Source: http://tva.com/retireeportal/pdf/09_notice_of_change.pdf

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