Page 27 - Rx Drug Plan review for John

Cost
Cost Cost in
Retail Cost after after
before coverage
cost deductible coverag
deductible gap
gap

Olmesartan

medoxomil 40mg $11.31 $11.31 $11.31 $2.83 $3.95
tablet

Omega-3 acid ethyl
esters (usp) 1gm $20.77 $20.77 $8.31 $5.19 $3.95
capsule

Potassium chloride
10meq capsule $58.37 $58.37 $58.37 $58.37 $58.37
extended release [ 1 ]

Pravastatin sodium
10mg tablet $3.60 $3.60 $3.60 $0.90 $3.60

Monthly totals $892.96 $890.40 $185.91 $271.55 $126.89

[1]
This plan does not cover this drug, the price shown is the full cash price.

[2]
This plan does not cover this drug at the selected frequency, so the price shown represents the full cash

price.