Page 27 - Evaluation for John Shartle

11/3/2017 Your Plan Results
Retail $76.50 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 4 out of 5 stars
Preferred Cost- $7 - $37, 33% - 40% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $3,703 MTM Program : Yes
Your current plan
Mail Order
Annual: $2,424
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 Enroll
$405 Formulary :Yes
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: $3,693 MTM Program : Yes
Approx. $435 more
Mail Order
Annual: $2,462 expensive than
First Health Part D Value Plus (PDP) (S5768-128-0) Express Scripts
Organization: First Health Part D Value plan.
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $56.30 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 3 out of 5 stars
Preferred Cost- $1 - $47, 33% - 50% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $2,506 MTM Program : Yes
Mail Order
Annual: $2,544
Humana Enhanced (PDP) (S5884-004-0)
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 $77.90 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 3.5 out of 5 stars
Standard Cost- $3 - $42, 33% - 44% Drug Restrictions: Yes
Sharing Lower Your Drug Costs

Annual: $3,937 MTM Program : Yes
Mail Order
Annual: $2,652
Express Scripts Medicare - Choice (PDP) (S5660-208-0)
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 $92.60 Annual Drug Deductible: All Your Drugs on Enroll
$350 Formulary :Yes
Pharmacy Status: 4 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $2 - $42, 26% - 48% Lower Your Drug Costs
Annual: $3,899 MTM Program : Yes

Mail Order
Annual: $3,120
EnvisionRxPlus (PDP) (S7694-005-0)
Organization: EnvisionRx Plus

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