Page 136 - Cover Letter and Evaluation for Gary Janke
P. 136
10/8/2018 Your Plan Results
Retail $49.50 Annual Drug Deductible: All Your Drugs on Formulary Coming Soon Enrollment begins
$0 :Yes October 15, 2018
Pharmacy Status:
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $35, 33% - 40% Lower Your Drug Costs
Annual: $2,226 MTM Program : Yes
Mail Order
Annual: $2,154
BlueRx Essential (PDP) (S1030-006-0)
Organization: BlueRx (PDP)
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $34.40 Annual Drug Deductible: All Your Drugs on Formulary Coming Soon Enrollment begins
$415 :Yes October 15, 2018
Pharmacy Status:
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $47, 25% - 50% Lower Your Drug Costs
Annual: $2,474 MTM Program : Yes
Mail Order
Annual: $2,279
AARP MedicareRx Saver Plus (PDP) (S5921-357-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $30.20 Annual Drug Deductible: All Your Drugs on Formulary Coming Soon Enrollment begins
$415 :No October 15, 2018
Pharmacy Status:
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $25, 25% - 33% Lower Your Drug Costs
Annual: $2,316 MTM Program : Yes
Mail Order
Annual: $2,299
SilverScript Allure (PDP) (S5601-154-0)
Organization: SilverScript
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $80.00 Annual Drug Deductible: All Your Drugs on Formulary Coming Soon Enrollment begins
$0 :Yes October 15, 2018
Pharmacy Status:
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $5, 20% - 40% Lower Your Drug Costs
Annual: $2,380 MTM Program : Yes
Mail Order
Annual: $2,315
SilverScript Choice (PDP) (S5601-024-0)
Organization: SilverScript
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $29.60 Annual Drug Deductible: All Your Drugs on Formulary Coming Soon Enrollment begins
$0 :Yes October 15, 2018
Pharmacy Status:
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $3 - $44, 33% - 47% Lower Your Drug Costs
Annual: $2,248 MTM Program : Yes
Mail Order
Annual: $2,321
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