Page 12 - Cover Letter and Evaluation for Susan Church
P. 12
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
Client preference: monthly refills at a usually get the lowest prices at one of your plan's preferred
CVS Pharmacy pharmacies. Some plans, though, do not have preferred
pharmacies.
Is CVS a preferred pharmacy in these plans?
SilverScript Choice Prescription Drug Yes. Wender & Roberts Pharmacy is also preferred
Plan (Part D stand-alone plan)
Yes, Wender & Roberts Pharmacy and Ms-Rx Pharmacy are
Humana Gold Plus HMO Plan
also preferred
Yes, Wender & Roberts Pharmacy and Ms-Rx Pharmacy are
Humana Choice PPO Plan (H5216-147)
also preferred
Yes, Wender & Roberts Pharmacy and Ms-Rx Pharmacy are
Humana Choice PPO Plan (H5216-153) also preferred
y g
The lowest-cost Part D stand-alone plan and Advantage plan for your drugs
SilverScript Choice
Prescription Drug Plan (Part D Humana Gold Plus HMO Plan
To enroll in a plan, call its toll-free stand-alone plan)
number (866) 552-6106 see pages 2-3
Est. annual costs for monthly refills at $773 $903
CVS
Est. annual costs with mail-order refills $712 $606
This plan's Medicare quality rating 3.5 out of 5 stars 3.5 out of 5 stars
The two other Advantage plans' costs for your drugs
These two Medicare Advantage plans
include prescription drug and medical Humana Choice PPO Plan (H5216- Humana Choice PPO Plan (H5216-
147)
153)
coverage
Est. annual costs with monthly refills at $984 $1,020
CVS
Est. annual costs with mail-order refills $606 $606
This plan's Medicare quality rating 4 out of 5 stars 4 out of 5 stars
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