Page 24 - APPENDICES for Vic Bosiger

ESTIMATED TOTAL MONTHLY DRUG COST

CVS Pharmacy #07948
Standard in-network pharmacy

January $169.51

February $169.51

March $386.12

April $433.66

May $433.66

June $433.66

July $295.91

August $125.27

September $125.27

October $125.27

November $125.27

December $125.27

ESTIMATED DRUG COSTS DURING COVERAGE PHASES