Page 98 - Appendices to Heidi Bathon's Evaluation

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 Walmart Pharmacy Mail Order
Pharmacy 10-3720 Walgreens #19577 Pharmacy
#05381 Preferred Preferred
Preferred Preferred Preferred Preferred
Standard in- in- in-
in- network network network
network pharmacy pharmacy pharmacy
pharmacy

Alprazolam
$61.24 $75.06 $60.50 $6.64
0.25mg tablet

Creon 6000-
19000unit
capsule
$531.20 $554.75 $521.76 $503.81
delayed
release
particles

Diclofenac
epolamine $2,879.80 $2,719.12 $2,719.60 $2,604.24
1.3% patch

Duloxetine
60mg capsule
delayed $112.94 $74.85 $58.54 $19.14
release
particles

Estradiol
0.1mg/gm $352.56 $351.49 $414.64 $418.48
cream

Levothyroxine
sodium $66.64 $21.87 $34.24 $15.10
50mcg tablet

Mirtazapine
45mg tablet $121.60 $70.37 $60.24 $22.48