Page 62 - APPENDICES for Neill McLauchlin
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This doesn't include your monthly plan premium of $0.00.
View the costs of your drugs every month
Time period Estimated monthly drug costs
April $89.58
May $89.58
June $89.58
July $89.58
August $89.58
September $89.58
October $89.58
November $89.58
December $89.58
Mail order pharmacy - Drug costs during coverage phases
Cost in
Retail Cost after Cost after
Selected drugs coverage
cost deductible coverage gap
gap
Lisinopril 40mg tablet $24.30 $0.00 $6.08 $3.70
Methimazole 5mg tablet $9.45 $0.00 $2.36 $3.70
Propranolol hydrochloride 120mg capsule
$95.40 $95.40 $23.85 $4.77
extended release 24 hour
Tolterodine tartrate 4mg capsule extended
$710.10 $126.00 $177.53 $35.51
release 24 hour
Monthly totals $839.25 $221.40 $209.82 $47.68
Estimated total drug + premium cost
