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PDP Shopping Questionnaire 2021
Would you like to receive a text message with your plan information (in addition to an email)?
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Shopping Location Preference (choose 1 or both)

Finding the most appropriate Prescription Drug Plan requires us to have a list of your current medications. Please provide a list of your current medications, including any "as needed" medications that you expect to fill in 2022. *Please exclude any OTC meds or vitamins you may take.

Please indicate if there are any other products you would like to discuss (in addition to Prescription)