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3/7/2017 MonthlyCostChart
Show monthly cost chart for:
M o n th ly C o s t C h a rt
CVS Pharmacy #
Walgreens #1990
Mail Order Pharmacy
First Health Part D Value Plus (PDP)
(S5768 134) Plan Type: PDP
Detailed Monthly costs for Walgreens #1990
View All Months
MONTH ITEM COVERAGE LEVEL YOUR COST TOTAL DRUG COST
1 Amlodipine Initial Coverage Level $47.00 $47.25
Besylate/Atorvastatin Calcium
TAB 1020MG
Bupropion Hcl TAB 300MG XL Initial Coverage Level $25.49 $25.49
Levothyroxine Sodium TAB 100MCG Initial Coverage Level $2.00 $2.59
Drug Premium NA $39.60 n/a
MONTH 1 TOTAL $114.09 $75.33
2 MONTH 2 TOTAL $114.09 $75.33
3 If you get monthly MONTH 3 TOTAL $114.09 $75.33
4 refills at Walgreens, MONTH 4 TOTAL $114.09 $75.33
5 MONTH 5 TOTAL $114.09 $75.33
your annual costs in
6 MONTH 6 TOTAL $114.09 $75.33
the First Health Part
7 MONTH 7 TOTAL $114.09 $75.33
D Value Plus plan
8 MONTH 8 TOTAL $114.09 $75.33
are $1,369.
9 MONTH 9 TOTAL $114.09 $75.33
10 MONTH 10 TOTAL $114.09 $75.33
11 MONTH 11 TOTAL $114.09 $75.33
12 MONTH 12 TOTAL $114.09 $75.33
Aetna Medicare Rx Saver (PDP)
(S5810 045) Plan Type: PDP
Detailed Monthly costs for Walgreens #1990
View All Months
MONTH ITEM COVERAGE LEVEL YOUR COST TOTAL DRUG COST
1 Amlodipine Deductible $40.04 $40.04
Besylate/Atorvastatin Calcium
TAB 1020MG
Bupropion Hcl TAB 300MG XL Deductible $25.49 $25.49
Levothyroxine Sodium TAB 100MCG Deductible $1.00 $1.64
Drug Premium NA $42.80 n/a
MONTH 1 TOTAL $109.33 $67.17
2 MONTH 2 TOTAL $109.33 $67.17
3 MONTH 3 TOTAL $109.33 $67.17
If you get monthly refills
4 MONTH 4 TOTAL $109.33 $67.17
at Walgreens, your
5 MONTH 5 TOTAL $109.33 $67.17
6 annual costs in the Aetna MONTH 6 TOTAL $109.33 $67.17
7 Medicare Rx Saver plan MONTH 7 TOTAL $104.29 $67.17
8 are $1,282. MONTH 8 TOTAL $104.29 $67.17
9 MONTH 9 TOTAL $104.29 $67.17
10 MONTH 10 TOTAL $104.29 $67.17
11 MONTH 11 TOTAL $104.29 $67.17
12 MONTH 12 TOTAL $104.29 $67.17
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