Page 21 - Rx Drug Plan review for John

Costco
Walgreens #6126 Pharmacy CVS Pharmacy
#05267
Preferred Preferred #746
in-network Out-of- Standard in-

pharmacy network network
pharmacy
pharmacy

Multaq 400mg
tablet $1,686.02 $9,955.20 $1,701.94

Olmesartan
medoxomil 40mg $84.84 $3,368.40 $181.54
tablet

Omega-3 acid ethyl
esters (usp) 1gm $93.46 $3,203.04 $143.26
capsule

Potassium chloride

10meq capsule $700.44 $686.04 $695.04
extended release

Pravastatin sodium
10mg tablet $27.00 $1,134.24 $46.93

Total yearly drug
cost $3,057.26 $25,665.12 $3,588.70