Page 62 - Appendices for Rick Leininger

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Cost in
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Retail l C o s t b e f o r e C o s t a f t e r C o s t a f t e r
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Cost after
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Cost before
Selected drugs
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S e l e c t e d d r u g s coverage
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deductible
coverage gap
deductible
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cost
gap
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Metoprolol tartrate
$72.55 $1.00 $1.00 $18.14 $3.70
37.5mg tablet
Pravastatin sodium 10mg
$8.95 $1.00 $1.00 $2.24 $3.70
tablet
Tamsulosin hydrochloride
$15.55 $3.00 $3.00 $3.89 $3.70
0.4mg capsule
Xarelto 20mg tablet $480.65 $480.65 $40.00 $120.16 $24.03
Monthly totals $577.70 $485.65 $45.00 $144.43 $35.13
Estimated total drug + premium cost
You will pay $848.75 per year on drug + premium costs.
Based on current drug costs, it's estimated that:
You'll meet your $445.00 deductible in June
You won't enter the coverage gap this year
Costs for 7 months is $848.75, including
premiums and co-pays. Costs for 6 months
are $58.30 less ($45 in co-payments +
Estimated monthly drug costs $13.30 premium for one month). So, costs
for 6 months are $790.45.
This doesn't include your monthly plan premium of $13.30.

View the costs of your drugs every month

Time period Estimated monthly drug costs

June $485.65

July $45.00

August $45.00

September $45.00

October $45.00

November $45.00

December $45.00