Page 28 - Evaluation for John Shartle

11/3/2017 Your Plan Results
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $12.60 Annual Drug Deductible: All Your Drugs on Enroll
$300 Formulary :No
Pharmacy Status: 3 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: No
Sharing $1 - $29, 27% - 39% Lower Your Drug Costs
Annual: $3,861 MTM Program : Yes
Mail Order
Annual: $3,766
Express Scripts Medicare - Saver (PDP) (S5660-221-0)
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 $22.60 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :No
Pharmacy Status: 4 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $4, 18% - 44% Lower Your Drug Costs
Annual: $4,364 MTM Program : Yes
Mail Order
Annual: $4,238
AARP MedicareRx Walgreens (PDP) (S5921-387-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $26.70 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :No
Pharmacy Status: 3.5 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $31, 25% - 32% Lower Your Drug Costs
Annual: $8,342 MTM Program : Yes
Mail Order
Annual: $6,692
Cigna-HealthSpring Rx Secure-Extra (PDP) (S5617-250-0)
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 $52.90 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :No
Pharmacy Status: Drug Copay/ Coinsurance: 2 out of 5 stars
Standard Cost- $4 - $42, 33% - 50% Drug Restrictions: Yes
Sharing Lower Your Drug Costs

Annual: $6,901 MTM Program : Yes
Mail Order
Annual: $6,810
Cigna-HealthSpring Rx Secure (PDP) (S5617-214-0)
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 $29.90 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :No
Pharmacy Status: 2 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $2 - $35, 25% - 40% Lower Your Drug Costs
Annual: $6,853 MTM Program : Yes

Mail Order
Annual: $6,838

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