Please fill in the following information so we can properly do an analysis and help you find your RX plan or review your current Medicare Supplement plan. If you are married you will need to fill out two different forms.    Please specify if taking tablet or capsule. Do not include OTC items, vitamins or diabetic supplies. Only prescribed medications.   When taking a generic medication give us that drug NOT the brand as it will save you money.  Do not hit “Enter” or “Return” use down arrows to navigate.  “Enter” will submit the form.  Instead of “As needed” please tell us how many times per year you fill that medication.