Page 82 - Evaluation with Cover Letter for Henry Rose

9/16/2017 Your Plan Results
Retail $38.60 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 3.5 out of 5 stars
Preferred Cost- $2 - $47, 33% - 50% Drug Restrictions: No
Sharing Lower Your Drug Costs
Cost as of Today: MTM Program : Yes
$143

Mail Order
Cost as of Today:
$142
Symphonix Value Rx (PDP) (S0522-008-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $29.70 Annual Drug Deductible: All Your Drugs on Enroll
$400 Formulary :Yes
Pharmacy Status: 2.5 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $26, 25% - 35% Lower Your Drug Costs
Cost as of Today: MTM Program : Yes
$179
Mail Order
Cost as of Today:
$179
Cigna-HealthSpring Rx Secure (PDP) (S5617-216-0)
Organization: Cigna-HealthSpring Rx
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $27.50 Annual Drug Deductible: All Your Drugs on Enroll
$400 Formulary :Yes
Pharmacy Status: 3 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $2 - $40, 25% - 42% Lower Your Drug Costs
Cost as of Today: MTM Program : Yes
$159
Mail Order
Cost as of Today:
$180
Humana Preferred Rx Plan (PDP) (S5884-132-0)
Organization: Humana Insurance Company
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $28.10 Annual Drug Deductible: All Your Drugs on Enroll
$400 Formulary :Yes
Pharmacy Status: 3 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $1, 20% - 35% Lower Your Drug Costs
Cost as of Today: MTM Program : Yes
$186
Mail Order
Cost as of Today:
$180
SilverScript Choice (PDP) (S5601-014-0)
Organization: SilverScript
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:

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