Page 101 - Appendices to Heidi Bathon's Evaluation
P. 101
ESTIMATED TOTAL MONTHLY DRUG COST
CVS
Pharmacy Walmart Pharmacy Walgreens #19577 Mail Order
Pharmacy
10-3720
#05381 Preferred Preferred Preferred Preferred Preferred Preferred
Standard in- in- in-
in- network network network
network pharmacy
pharmacy pharmacy pharmacy
January $528.63 $456.56 $459.31 $1,145.82
February $508.21 $436.54 $439.14 -
March $528.63 $456.56 $459.31 -
April $508.21 $436.54 $439.14 $814.53
May $311.36 $374.26 $294.03 -
June $271.43 $262.45 $273.00 -
July $276.53 $267.45 $278.04 $841.01
August $271.43 $262.45 $273.00 -
September $276.53 $267.45 $278.04 -
October $271.43 $262.45 $273.00 $841.01
November $276.53 $267.45 $278.04 -
December $271.43 $262.45 $273.00 -
ESTIMATED DRUG COSTS DURING COVERAGE PHASES
The drug prices shown may vary based on the plan and pharmacy you've selected. Contact the plan if you have speci c questions
about drug costs.
Learn more about coverage phases.
