347 N. Pottstown Pike, Suite 200 | Exton, PA 19341

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PDP Shopping Questionnaire

PDP Shopping Questionnaire

Please complete form if you would like HTA to review your Prescription Drug Coverage for plan year 2022.
*Prescription Drug Plans can only be shopped between October 15th and December 7th annually. PLEASE NOTE, WE CAN ONLY ACCEPT REQUESTS UNTIL SUNDAY 11/28/2021 to allow enough time for analysis prior to the 12/7/2021 enrollment deadline.

**Due to high call volumes this time of year, Prescription Drug Plan/Medicare Advantage Plan Shopping is only available to existing clients who are already enrolled through HTA in a Medicare Supplement/Medicare Advantage or Medicare Prescription Plan.

PLEASE COMPLETE A SEPARATE FORM FOR EACH SPOUSE.

Would you like to receive a text message with your plan information (in addition to an email)?
Change Preference
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)