Page 54 - Appendices for Eric Hartman
P. 54
WALGREENS #12140
Cost in
Retail Cost after Cost after
coverage
cost deductible coverage gap
gap
Atorvastatin 10mg
tablet $12.55 $12.55 $12.55 $4.15
Finasteride 5mg tablet $13.67 $7.00 $7.00 $4.15
Levothyroxine sodium
25mcg tablet $57.17 $7.00 $7.00 $4.15
Terazosin 2mg capsule $17.87 $7.00 $7.00 $4.15
Monthly totals $101.26 $33.55 $33.55 $16.60
