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PLEASE NOTE: This page is for CURRENT customers of Brines' Insurance & Financial Services ONLY.

If you received our letter and/or your agent is either Russell "Rusty" Brines or Erika Withrow, you're in the right spot!

If you have never worked with us before, please call us at 530-895-0110 before proceeding.


If you would like us to determine which prescription plan would be most affordable to you for the 2022 calendar year, please fill out the form below.

Part D Prescription Form

Make sure to click the "submit" button when you're finished. A confirmation message of

"Your List Has Been Successfully Submitted" will appear at the bottom of the screen.

If you do not list a pharmacy, we will use default pharmacies that have a tendency to have lower drug costs.

Please be precise when listing your prescriptions.

The plan results will be based on the drugs exactly as you type them.

Your List Has Been Successfully Submitted!

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