Page 14 - Cover Letter and Evaluation for Sarah Spero

Your Prescription Drug Costs

These costs are for your prescription drugs and are based on the dosages and monthly quantities that
you use. These costs include premiums, deductible, and co-payments.

Pharmacy Information

When you need a retail prescription filled or refilled, you will
Rite Aid usually get the lowest prices at one of your plan's preferred

pharmacies. Some plans, though, do not have preferred
Monthly pharmacies.

Is Rite Aid a preferred pharmacy in this plan?

Anthem Blue Cross MediBlue Rx
Enhanced PDP No

Blue Shield 65 Plus HMO Plan No

Scripps Classic offered by SCAN (an
HMO) Yes

y g
The lowest-cost Part D stand-alone plans for your drugs

If you get a Medigap policy, you will also Anthem Blue Cross MediBlue
need to enroll in a stand-alone drug Rx Enhanced PDP
plan. To enroll, call the plan's toll-free
number (800) 261-8667

Est. 3-month costs for mail-order refills $139

Est. 3 month costs for monthly refills at $146
preferred pharmacy

This plan's Medicare quality rating 4 out of 5 stars

Medicare Advantage plans' costs for your drugs

This Medicare Advantage plan includes Scripps Classic offered by SCAN
prescription drug and medical coverage Blue Shield 65 Plus HMO Plan (an HMO)

Est. 3-month costs for mail-order $14 $0

Est. 3-month costs for monthly refills at $15 $45
a preferred pharmacy
This plan's Medicare quality rating 4 out of 5 stars 4.5 out of 5 stars

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