Page 72 - Cover Letter and Evaluation for Bob Workman

10/25/2017 Your Medicare Health Plan Comparison
All of your drugs are covered on the plan’s formulary. All of your drugs are covered on the plan’s formulary.
Losartan Potassium TAB 50MG Losartan Potassium TAB 50MG
No restrictions No restrictions

Tier 1: Preferred Generic Tier 1: Preferred Generic
Metoprolol Succinate Er TAB 100MG ER Metoprolol Succinate Er TAB 100MG ER
No restrictions No restrictions

Tier 2: Generic Tier 2: Generic
Montelukast Sodium TAB 10MG Montelukast Sodium TAB 10MG
No restrictions No restrictions
Tier 2: Generic Tier 1: Preferred Generic
Ventolin HFA AER Ventolin HFA AER
Quantity Limit Quantity Limit

Tier 3: Preferred Brand Tier 3: Preferred Brand

Print My Drug List Print Comparison Report

Pharmacy & Mail Order Information

Mail Order is available. Mail Order is available.
Pharmacy Network Pharmacy Network
6 network pharmacies in your ZIP code 6 network pharmacies in your ZIP code
Preferred pharmacy network available Preferred pharmacy network available

Drug List

Add/Edit Drugs

MEDICINE NAME QUANTITY FREQUENCY & GENERIC OPTIONS ACTION
PHARMACY

Change dose Add
LOSARTAN POTASSIUM TAB 45 Every 1 Month Already Generic Remove
50MG Retail Pharmacy

Change dose Add
METOPROLOL SUCCINATE ER 30 Every 1 Month Already Generic Remove
TAB 100MG ER Retail Pharmacy

Change dose Add
MONTELUKAST SODIUM TAB 30 Every 1 Month Already Generic Remove
10MG Retail Pharmacy

Change dose Add
VENTOLIN HFA AER 1 X 8GM Inhaler Every 2 Months Generic Not Available Remove
Retail Pharmacy

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