Page 179 - Cover Letter and Evaluation for Sue Marx

2/7/2019 Your Medicare Health Plan Details
Mail Order is available.
Pharmacy Network [?]
8 network pharmacies in your ZIP code
Preferred pharmacy network available [?]

Drug List

Add/Edit Drugs

MEDICINE NAME QUANTITY FREQUENCY & GENERIC OPTIONS ACTION
PHARMACY
Change dose Add
AMITRIPTYLINE HCL TAB 25MG 30 Every 1 Month Already Generic Remove
Retail Pharmacy

Change dose Add
BUSPIRONE HCL TAB 10MG 30 Every 1 Month Already Generic Remove
Retail Pharmacy

Change dose Add
HUMIRA PEN INJ 40MG/0.8 1 X 1 Box of 1 Every 1 Month Generic Not Available Remove
kits (sold in a Retail Pharmacy
package of 2
kits)

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https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=H5522&plnid=001&sgmntid=0#plan_drug_cost 3/3