List Your Medications Below

Please list your medications below so that I can prepare a customized Drug Plan Analysis for you. I will shop all available options!


INSTRUCTIONS:

Vitamins & Supplements: Do not list these if they are available over the counter. Medicare will not cover them. Medicare covers very few supplements.

Creams & Liquids: List the strength (dosage) and the size of the container (bottle, tube or jar) that it comes in. Then indicate how many per month.

Insulin: Indicate if you use syringes or pens. If you use syringes indicate the dosage and how many vials per month. If you use pens, provide the dosage and how many pens per month.