Welcome to our drug plan recommendation online form.

• Please answer all questions.   
• Your recommendation will be ready in 7 business days.  
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Summary of Prescription Drug #1:

• Name of Medication: {nameOf}
• Version:  {whatVersion625}
• Looks Like:  {whatDoes}
• Dosage / Strength:  {whatIs}
• You Take: {iNeed845}{howOften}
• You Need This Much for a 30-day Supply:  {quantityNeeded}

Summary of Prescription Drug #2:

• Name of Medication: {nameOf1507}
• Version:  {whatVersion}
• Looks Like:  {whatDoes1509}
• Dosage / Strength:  {whatIs1510}
• You Take:  {iNeed} {howOften1512}
• You Need This Much for a 30-day Supply:  {quantityNeeded1513}

Summary of Prescription Drug #3:

• Name of Medication: {nameOf1519}
• Version:  {whatVersion1520}
• Looks Like:  {whatDoes1521}
• Dosage / Strength:  {whatIs1522}
• You Take:  {iNeed1523} {howOften1524}
• You Need This Much for a 30-day Supply:  {quantityNeeded1525}

Summary of Prescription Drug #4:

• Name of Medication: {nameOf1531}
• Version:  {whatVersion1532}
• Looks Like:  {whatDoes1533}
• Dosage / Strength:  {whatIs1534} {iNeed1535}
• You Take:  {howOften1536}
• You Need This Much for a 30-day Supply:  {quantityNeeded1537}

Summary of Prescription Drug #5:

• Name of Medication: {nameOf1543}
• Version:  {whatVersion1544}
• Looks Like:  {whatDoes1545}
• Dosage / Strength:  {whatIs1546}
• You Take:  {iNeed1547} {howOften1548}
• You Need This Much for a 30-day Supply:  {quantityNeeded1549}

Summary of Prescription Drug #6:

• Name of Medication: {nameOf1555}
• Version:  {whatVersion1556}
• Looks Like:  {whatDoes1557}
• Dosage / Strength:  {whatIs1558}
• You Take:  {iNeed1559} {howOften1560}
• You Need This Much for a 30-day Supply:  {quantityNeeded1561}

Summary of Prescription Drug #7:

• Name of Medication:  {nameOf1567}
• Version:  {whatVersion1568}
• Looks Like:  {whatDoes1569}
• Dosage / Strength:  {whatIs1570}
• You Take:  {iNeed1571} {howOften1572}
• You Need This Much for a 30-day Supply:  {quantityNeeded1573}

Summary of Prescription Drug #8:

• Name of Medication: {nameOf1579}
• Version:  {whatVersion1580}
• Looks Like:  {whatDoes1581} 
• Dosage / Strength:  {whatIs1582}
• You Take:  {iNeed1583} {howOften1584}
• You Need This Much for a 30-day Supply:  {quantityNeeded1585}

Summary of Prescription Drug #9:

• Name of Medication:  {nameOf1591}
• Version:  {whatVersion1592}
• Looks Like:  {whatDoes1593}
• Dosage / Strength:  {whatIs1594}
• You Take:  {iNeed1595} {howOften1596}
• You Need This Much for a 30-day Supply:  {quantityNeeded1597}

Summary of Prescription Drug #10:

• Name of Medication:  {nameOf1603}
• Version:  {whatVersion1604}
• Looks Like:  {whatDoes1605}
• Dosage / Strength:  {whatIs1606}
• You Take:  {iNeed1607} {howOften1608}
• You Need This Much for a 30-day Supply:  {quantityNeeded1609}

Summary of Prescription Drug #11:

• Name of Medication: {nameOf1615}
• Version:  {whatVersion1616}
• Looks Like:  {whatDoes1617}
• Dosage / Strength:  {whatIs1618}
• You Take:  {iNeed1619} {howOften1620}
• You Need This Much for a 30-day Supply:  {quantityNeeded1621}

Summary of Prescription Drug #12:

• Name of Medication: {nameOf1627}
• Version:  {whatVersion1628}
• Looks Like:  {whatDoes1629}
• Dosage / Strength:  {whatIs1630}
• You Take:  {iNeed1631} {howOften1632}
• You Need This Much for a 30-day Supply:  {quantityNeeded1633}

Summary of Prescription Drug #13:

• Name of Medication: {nameOf1639}
• Version:  {whatVersion1640}
• Looks Like:  {whatDoes1641}
• Dosage / Strength:  {whatIs1642}
• You Take:  {iNeed1643} {howOften1644}
• You Need This Much for a 30-day Supply:  {quantityNeeded1645}

Summary of Prescription Drug #14:

• Name of Medication: {nameOf1651}
• Version:  {whatVersion1652}
• Looks Like:  {whatDoes1653}
• Dosage / Strength:  {whatIs1654}
• You Take:  {iNeed1655} {howOften1656}
• You Need This Much for a 30-day Supply:  {quantityNeeded1657}

Summary of Prescription Drug #15:

• Name of Medication: {nameOf1663}
• Version: {whatVersion1664}
• Looks Like: {whatDoes1665}
• Dosage / Strength: {whatIs1666}
• You Take: {iNeed1667} {howOften1668}
• You Need This Much for a 30-day Supply: {quantityNeeded1669}

I'm ready to get a drug plan recommendation based on this list of medications. 

*If you do not take any medications, this will be blank.

Please review and then scroll down and press "SUBMIT DRUG LIST".

====================================

Your current list of medications:

1. {nameOf} {whatIs} {whatDoes}
2. {nameOf1507} {whatIs1510} {whatDoes1509}
3. {nameOf1519} {whatIs1522} {whatDoes1521}
4. {nameOf1531} {whatIs1534} {whatDoes1533}
5. {nameOf1543} {whatIs1546} {whatDoes1545}
6. {nameOf1555} {whatIs1558} {whatDoes1557}
7. {nameOf1567} {whatIs1570} {whatDoes1569}
8. {nameOf1579} {whatIs1582} {whatDoes1581}
9. {nameOf1591} {whatIs1594} {whatDoes1593}
10. {nameOf1603} {whatIs1606} {whatDoes1605}
11. {nameOf1615} {whatIs1618} {whatDoes1617}
12. {nameOf1627} {whatIs1630} {whatDoes1629}
13. {nameOf1639} {whatIs1642} {whatDoes1641}
14. {nameOf1651} {whatIs1654} {whatDoes1653}
15. {nameOf1663} {whatIs1666} {whatDoes1665}