Page 75 - Cover letter and evaluation for Thomas Barr

10/14/2017 Your Plan Results
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $17.70 Annual Drug Deductible: All Your Drugs on Enrollment begins
$405 Formulary :Yes October 15, 2017
Pharmacy Status: 3.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $47, 25% - 42% Lower Your Drug Costs
Annual: $212 MTM Program : Yes
Mail Order
Annual: N/A
Express Scripts Medicare - Saver (PDP) (S5660-221-0)
Organization: Express Scripts Medicare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $22.60 Annual Drug Deductible: All Your Drugs on Enrollment begins
$405 Formulary :Yes October 15, 2017
Pharmacy Status: 4 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $4, 18% - 44% Lower Your Drug Costs
Annual: $283 MTM Program : Yes
Mail Order
Annual: $279
Humana Walmart Rx Plan (PDP) (S5884-151-0)
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 $20.40 Annual Drug Deductible: All Your Drugs on Enrollment begins
$405 Formulary :Yes October 15, 2017
Pharmacy Status: 3.5 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $4, 23% - 35% Lower Your Drug Costs
Annual: $305 MTM Program : Yes
Mail Order
Annual: $277
Symphonix Value Rx (PDP) (S0522-006-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $25.50 Annual Drug Deductible: All Your Drugs on Enrollment begins
$405 Formulary :Yes October 15, 2017
Pharmacy Status: 3 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $35, 25% Lower Your Drug Costs

Annual: $327 MTM Program : Yes
Mail Order
Annual: $330
WellCare Classic (PDP) (S4802-079-0)
Organization: WellCare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $29.90 Annual Drug Deductible: All Your Drugs on Enrollment begins
$405 Formulary :Yes October 15, 2017
Pharmacy Status: 2.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: No
Sharing $0 - $37, 25% - 48% Lower Your Drug Costs
Annual: $359 MTM Program : Yes

Mail Order
Annual: $359

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