Page 88 - Cover Letter and Evaluation for Debbie Workman

12/13/2017 Your Plan Results
WellCare Classic (PDP) (S4802-020-0)
Organization: WellCare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $30.30 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 2.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $29, 25% - 34% Lower Your Drug Costs
Annual: MTM Program : Yes
Mail Order
Annual: $499
SilverScript Choice (PDP) (S5601-060-0)
Organization: SilverScript
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $30.40 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 4 out of 5 stars
Preferred Cost- $3 - $34, 33% - 34% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: MTM Program : Yes

Mail Order
Annual: $525
Cigna-HealthSpring Rx Secure (PDP) (S5617-148-0)
Organization: Cigna-HealthSpring Rx
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $28.70 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 2 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $35, 25% - 40% Lower Your Drug Costs
Annual: MTM Program : Yes
Mail Order
Annual: $588
Symphonix Value Rx (PDP) (S0522-030-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $28.10 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 3 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $29, 25% - 30% Lower Your Drug Costs
Annual: MTM Program : Yes
Mail Order
Annual: $692

Notes:
Your costs may be different depending on your Part B premium, any Part D penalty that may apply, and whether you qualify for
Extra Help from Medicare paying your drug costs.

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