Page 50 - Appendices for Eric Hartman
P. 50
YEARLY DRUG COSTS BY PHARMACY
Drug costs shown vary based on the plan and pharmacy that you use. Contact the plan if you have speci c
questions about drug costs. Can my drug costs change by pharmacy?
CVS Pharmacy Walgreens Mail Order
#09373 #12140 Pharmacy
Preferred In-network Preferred
Atorvastatin 10mg
tablet $0.00 $75.30 $0.00
Finasteride 5mg tablet $0.00 $84.00 $0.00
Levothyroxine sodium
25mcg tablet $84.00 $0.00
$0.00
Terazosin 2mg capsule $0.00 $84.00 $0.00
Total yearly drug cost $0.00 $327.30 $0.00
