Page 97 - Appendices for Eric Hartman
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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 #12140 Mail Order
#09373 Pharmacy
Out-of-network
Preferred Preferred
Atorvastatin 10mg
tablet $13.56 $713.22 $11.16
Finasteride 5mg
tablet $24.00 $1,103.04 $22.48
Levothyroxine sodium
25mcg tablet $24.00 $176.40 $22.40
Terazosin 2mg
capsule $24.00 $1,098.60 $24.00
Total yearly drug cost $85.56 $3,091.26 $80.04
