Page 12 - Cover letter and evaluation for Michele Buros

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.

Preferred Pharmacy Information

When you need a retail prescription filled or refilled, you will
Refill Schedule: Monthly (retail)
usually get the lowest prices at one of your plan's preferred
pharmacies. Some plans, though, do not have preferred
Pharmacy: Giant Eagle pharmacies.

Is Giant Eagle a preferred pharmacy in the following plans' pharmacy networks?

Community Blue Medicare PPO Yes
Signature Plan

Advantra Silver PPO Plan Yes

Humana Value Plus PPO Plan Yes

Aetna Medicare Gold PPO Plan Yes

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2018 estimated Rx drug costs for the plans in your evaluation*

Estimated annual costs in Estimated annual costs in
Plan name
2018 for retail refills 2018 for mail-order refills

Community Blue Medicare PPO $155 $155
Signature Plan

Advantra Silver PPO Plan $264 $264

Humana Value Plus PPO Plan $329 $329

Aetna Medicare Gold PPO Plan $349 $301

*Estimated costs include plan premiums, deductibles, and co-payments

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