Rx/Provider Lookup

Please complete this form if you would like a Medicare Prescription Drug Plan Review or a Medicare Advantage Plan Review.

Name(Required)
Mail Order(Required)
Medications
Enter information exactly as shown on the bottle/container. To add additional medications, click the + symbol to the right of the fields below.
Drug Name
Dosage (MG amount)
Frequency (times per day)
 
Provider Search
Only fill out provider information if you are interested in a Medicare Advantage Plan. To add additional providers, click the + symbol to the right of the fields below.
First and Last Name
Specialty
City
Zip Code