Page 105 - APPENDICES for Fred Falten

Selected drugs Package Quantity Frequency Brand/Generic

Every
Amlodipine 2.5mg tablet 30 Generic
month

Every
Atorvastatin 20mg tablet 30 Generic
month

Metoprolol succinate 50mg tablet Every
30 Generic
extended release 24 hour month

Tamsulosin hydrochloride 0.4mg Every
60 Generic
capsule month

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PART B DRUGS

Chemotherapy drugs
Not covered

Other Part B drugs
Not covered

Star ratings

OVERALL STAR RATING

DRUG PLAN (PART D) STAR RATING