Page 42 - Memo to Michael Boucher

C o s t i n
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Selected drugs c o v e r a g e
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cost d e d u c t i b l e deductible coverage gap
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Flecainide acetate 50mg
$51.57 $51.57 $19.00 $12.89 $3.70
tablet
Praluent 75mg/ml
$475.60 $475.60 $46.00 $118.90 $23.78
solution auto injector
Monthly totals $527.17 $527.17 $65.00 $131.79 $27.48
Estimated total drug + premium cost
You will pay $1,033.54 per year on drug + premium costs.
Based on current drug costs, it's estimated that:
You'll meet your $445.00 deductible in May
You'll enter the coverage gap in December
You won't exit the coverage gap
Estimated monthly drug costs
This doesn't include your monthly plan premium of $7.30.
View the costs of your drugs every month
Time period Estimated monthly drug costs
May $491.00
June $65.00
July $65.00
August $65.00
September $65.00
October $65.00
November $65.00
December $86.84