Page 33 - 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 $26.90 $26.90 $26.90 $6.72 $3.95
tablet

Omega-3 acid ethyl
esters (usp) 1gm $31.49 $31.49 $14.17 $7.87 $3.95
capsule

Potassium chloride
10meq capsule $57.92 $57.92 $57.92 $57.92 $57.92
extended release [ 1 ]

Pravastatin sodium
10mg tablet $6.95 $6.95 $6.95 $1.74 $3.95

Monthly totals $985.53 $985.48 $274.88 $294.02 $128.07

[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.

COSTS BY DRUG TIER

Plans group their drug lists into tiers. The drug costs below show how much you'll pay for drugs in each tier
based on the coverage phase you're in.

Learn more about drug tiers.