Page 23 - Rx Drug Plan review for John
P. 23
ESTIMATED TOTAL MONTHLY DRUG COST
Costco CVS Pharmacy
Walgreens #6126 Pharmacy #746 #05267
Preferred Preferred in-
network Out-of- Standard in-
pharmacy network network
pharmacy pharmacy
January $408.37 $2,141.18 $427.92
February $179.87 $2,136.34 $269.29
March $185.91 $2,141.18 $274.88
April $179.87 $2,136.34 $269.29
May $185.91 $2,141.18 $324.11
June $319.74 $2,136.34 $288.43
July $267.02 $2,141.18 $289.83
August $265.51 $2,136.34 $288.43
September $267.02 $2,141.18 $289.83
October $265.51 $2,136.34 $288.43
November $267.02 $2,141.18 $289.83
