Page 36 - Cover Letter and Evaluation for Chris Parlin

10/11/2017 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 $30.30 Annual Drug Deductible: All Your Drugs on Enrollment begins
$350 Formulary :Yes October 15, 2017
Pharmacy Status: 3.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $30, 26% - 35% Lower Your Drug Costs
Annual: $1,492 MTM Program : Yes
Mail Order
Annual: $1,497
Lowest-cost mail-
EnvisionRxPlus (PDP) (S7694-005-0) order
Organization: EnvisionRx Plus
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 Enrollment begins
$300 Formulary :Yes October 15, 2017
Pharmacy Status: 3 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $29, 27% - 39% Lower Your Drug Costs
Annual: $1,509 MTM Program : Yes
Mail Order
Annual: $1,327
SilverScript Choice (PDP) (S5601-010-0)
Organization: SilverScript
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $29.50 Annual Drug Deductible: $0 All Your Drugs on Enrollment begins
Formulary :Yes October 15, 2017
Pharmacy Status: Drug Copay/ Coinsurance: 4 out of 5 stars
Preferred Cost- $9 - $46, 33% - 49% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $1,517 MTM Program : Yes
Mail Order
Annual: $1,361
Aetna Medicare Rx Select (PDP) (S5810-279-0)
Organization: Aetna Medicare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $17.70 Annual Drug Deductible: All Your Drugs on Enrollment begins
$405 Formulary :Yes October 15, 2017
Pharmacy Status: 3.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $47, 25% - 42% Lower Your Drug Costs

Annual: $1,595 MTM Program : Yes
Mail Order
Annual: N/A
First Health Part D Value Plus (PDP) (S5768-128-0)
Organization: First Health Part D
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 Enrollment begins
Formulary :Yes October 15, 2017
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: $1,612 MTM Program : Yes

Mail Order
Annual: $1,611

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