Page 12 - Evaluation for Tom Tappan
P. 12
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.
Pharmacy Information
When you need a retail prescription filled or refilled, you will
Client's pharmacy:
usually get the lowest prices at one of your plan's preferred
pharmacies. Some plans, though, do not have preferred
Walgreens
pharmacies.
Is Walgreens a preferred pharmacy in the following plans' pharmacy networks?
CVS and Osco are preferred
Aetna Medicare Rx Saver Plan No
pharmacies in this plan
CVS and Osco are preferred
First Health Part D Value Plus Plan No
pharmacies in this plan
Bank of America Silverscript Plan No Check with plan to see
Estimated retail costs for your drugs
The two lowest-cost Part D stand-alone plans for your drugs
Lowest cost stand- Aetna Medicare Rx Saver First Health Part D Value Plus
alone drug plan Prescription Drug Plan Prescription Drug Plan
To enroll in a plan, call its toll-free
number 855-338-7030 855-389-9688
Est. annual costs with monthly refills $4,097 $4,452
Est. annual costs with mail-order refills $4,678 $4,983
This plan's Medicare quality rating NA NA
BofA Silverscript Plan estimated costs for your drugs (see Appendix D1)
Retail costs are based on getting monthly refills at a network pharmacy.
Est. annual costs with monthly refills $0
Est. annual costs with mail-order refills $0
This plan's Medicare quality rating NA
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