Page 86 - Cover Letter and Evaluation for Mike Peaseley

11/17/2017 Your Plan Results
Express Scripts Medicare - Saver (PDP) (S5660-246-0)
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 :Yes
Pharmacy Status: 4 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $4, 18% - 43% Lower Your Drug Costs
Annual: $1,521 MTM Program : Yes
Mail Order
Annual: $1,451
AARP MedicareRx Walgreens (PDP) (S5921-411-0)
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 :Yes
Pharmacy Status: 3.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $31, 25% - 32% Lower Your Drug Costs
Annual: $1,538 MTM Program : Yes

Mail Order
Annual: $1,508
Cigna-HealthSpring Rx Secure (PDP) (S5617-148-0)
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 $28.70 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 2 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $35, 25% - 40% Lower Your Drug Costs
Annual: $1,573 MTM Program : Yes
Mail Order
Annual: $1,581
First Health Part D Value Plus (PDP) (S5768-153-0)
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 $56.20 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 3 out of 5 stars
Preferred Cost- $2 - $47, 33% - 47% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $1,589 MTM Program : Yes
Mail Order
Annual: $1,616

Notes:
Your costs may be different depending on your Part B premium, any Part D penalty that may apply, and whether you qualify for
Extra Help from Medicare paying your drug costs.

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