Page 57 - APPENDICES for Janet Tuma

Selected drugs Package Quantity Frequency Brand/Generic

Every
Hydrochlorothiazide 25mg tablet 30 Generic
month

Edit/Remove drugs

PART B DRUGS

Chemotherapy drugs
20% coinsurance

Limits apply

Other Part B drugs
20% coinsurance

Limits apply

Star ratings

OVERALL STAR RATING

HEALTH PLAN STAR RATINGS

DRUG PLAN (PART D) STAR RATING

Contact information

CONTACT INFORMATION