Page 63 - Appendices for Rick Leininger

Mail order pharmacy - Drug costs during coverage phases

Cost in
Retail Cost before Cost after Cost after
Selected drugs coverage
cost deductible deductible coverage gap
gap

Metoprolol tartrate
$205.20 $3.00 $3.00 $51.30 $10.26
37.5mg tablet

Pravastatin sodium 10mg
$24.30 $3.00 $3.00 $6.08 $3.70
tablet

Tamsulosin hydrochloride
$43.20 $9.00 $9.00 $10.80 $3.70
0.4mg capsule

Xarelto 20mg tablet $1,375.20 $1,375.20 $120.00 $343.80 $68.76

Monthly totals $1,647.90 $1,390.20 $135.00 $411.98 $86.42

Estimated total drug + premium cost

You will pay $1,146.53 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'll enter the coverage gap in December
You won't exit the coverage gap

Estimated monthly drug costs

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 $580.00

September $135.00

December $338.43