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COMPLETE THIS BRIEF FORM TO PROVIDE CONSENT FOR ENLIVENHEALTH (FORMERLY FDS
AMPLICARE) TO INITIATE MEDICARE PATIENT ENGAGEMENT CAMPAIGNS ON BEHALF OF YOUR
PHARMACY.

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The free text messages will be sent to Medicare-eligible patients (either newly
eligible or eligible during the Annual Enrollment Period) who have not recently
received a plan comparison. Patients can opt out at any time.

Patients will receive a text with a personalized link to Navigate, our
patient-facing plan finder. In Navigate, they will see plans tailored for their
prescriptions and your pharmacy. All of the plans shown are plans that are
in-network with your pharmacy. Your pharmacy’s name and phone number will be at
the end of every text.





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