Page 10 - Cover Letter and Cost Estimates for Ms. LaVerne Durham

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

Client's pharmacy: When you need a retail prescription filled or refilled, you will
usually get the lowest prices at one of your plan's preferred
NA pharmacies. Some plans do not have preferred pharmacies.

Is either CVS or Walgreens a preferred pharmacy in the following plans' networks?

Clear Spring Health Premier Rx CVS is a preferred pharmacy in this plan
Prescription Drug Plan (PDP)

Johns Hopkins Advantage MD Plan CVS and Walgreens are standard pharmacies in this plan
(HMO)

CareFirst BlueCross BlueShield CVS and Walgreens are standard pharmacies in this plan
Advantage Core Plan (HMO)

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The lowest-cost Part D stand-alone plan for your drugs

Clear Spring Health Premier Rx
To enroll in a plan, call its toll-free Prescription Drug Plan (PDP)
number

NA

Est. annual costs with monthly refills $260 at a CVS pharmacy

Est. annual costs with mail-order refills $308

This plan's Medicare quality rating Plan too new to be measured

Medicare Advantage plans' costs for your drugs

These two Medicare Advantage plans
include prescription drug and medical Johns Hopkins Advantage MD CareFirst BlueCross BlueShield
Advantage Core Plan (HMO)
Plan (HMO)
coverage
Est. annual costs with monthly refills $255 $351

Est. annual costs with mail-order refills $274 $396

This plan's Medicare quality rating 3.5 out of 5 stars Plan too new to be measured

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