Page 85 - Cover Letter and Evaluation for Mike Peaseley

11/17/2017 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 :Yes
Pharmacy Status: 3 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $34, 27% - 40% Lower Your Drug Costs
Annual: $1,261 MTM Program : Yes
Mail Order
Annual: $1,202
Aetna Medicare Rx Saver (PDP) (S5810-064-0)
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 $32.60 Annual Drug Deductible: All Your Drugs on Enroll
$320 Formulary :Yes
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: $1,354 MTM Program : Yes
Mail Order
Annual: $1,357
Express Scripts Medicare - Value (PDP) (S5660-132-0)
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 $49.60 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 4 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $18, 25% - 47% Lower Your Drug Costs
Annual: $1,439 MTM Program : Yes
Mail Order
Annual: $1,526
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: No
Sharing $0 - $29, 25% - 34% Lower Your Drug Costs

Annual: $1,451 MTM Program : Yes
Mail Order
Annual: $1,267
WellCare Value Script (PDP) (S4802-135-0)
Organization: WellCare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $37.20 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: No
Sharing $0 - $25, 25% Lower Your Drug Costs
Annual: $1,494 MTM Program : Yes

Mail Order
Annual: $1,309

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