Page 43 - Memo to Michael Boucher
P. 43
WALGREENS #6619 - Drug costs during coverage phases
Out-of-network pharmacy
You may have to pay the full cost for drugs. Choose an in-network pharmacy to get drugs at a lower
cost.
Cost in
Retail Cost before Cost after Cost after
Selected drugs coverage
cost deductible deductible coverage gap
gap
Flecainide acetate 50mg
$118.76 $118.76 $118.76 $118.76 $118.76
tablet
Praluent 75mg/ml
$540.00 $540.00 $540.00 $540.00 $540.00
solution auto injector
Monthly totals $658.76 $658.76 $658.76 $658.76 $658.76
Estimated total drug + premium cost
You will pay $5,335.78 per year on drug + premium costs.
Based on current drug costs, it's estimated that:
You'll meet your $445.00 deductible in June
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 $658.76
June $658.76
July $658.76
August $658.76
September $658.76
