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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
BlueMedicare HMO LifeTime (HMO)
(H1026 ­ 040) Plan Type: HMO
Detailed Monthly costs for Walgreens #1990
View All Months

MONTH ITEM COVERAGE LEVEL YOUR COST TOTAL DRUG COST
1 Amlodipine Initial Coverage Level $13.00 $161.88
Besylate/Atorvastatin Calcium
TAB 10­20MG
Bupropion Hcl TAB 300MG XL Initial Coverage Level $13.00 $23.07
Levothyroxine Sodium TAB 100MCG Initial Coverage Level $13.00 $15.35
Drug Premium NA $0.00 n/a
MONTH 1 TOTAL $39.00 $200.30
2 MONTH 2 TOTAL $39.00 $200.30
3 If you get monthly refills MONTH 3 TOTAL $39.00 $200.30
4 at Walgreens, your MONTH 4 TOTAL $39.00 $200.30
5 annual costs in the MONTH 5 TOTAL $39.00 $200.30
6 MONTH 6 TOTAL $39.00 $200.30
Blue Medicare Lifetime
7 MONTH 7 TOTAL $39.00 $200.30
HMO will be $468.
8 MONTH 8 TOTAL $39.00 $200.30
9 MONTH 9 TOTAL $39.00 $200.30
10 MONTH 10 TOTAL $39.00 $200.30
11 MONTH 11 TOTAL $39.00 $200.30
12 MONTH 12 TOTAL $39.00 $200.30
AARP MedicareComplete Choice Plan 2 (Regional PPO)
(R7444 ­ 003) Plan Type: Preferred Provider Organization
Detailed Monthly costs for Walgreens #1990
View All Months
MONTH ITEM COVERAGE LEVEL YOUR COST TOTAL DRUG COST
1 Amlodipine Deductible $2.00 $197.80
Besylate/Atorvastatin Calcium
TAB 10­20MG
Bupropion Hcl TAB 300MG XL Deductible $12.00 $62.90
Levothyroxine Sodium TAB 100MCG Deductible $2.00 $12.80
Drug Premium NA $0.00 n/a
MONTH 1 TOTAL $16.00 $273.50
2 MONTH 2 TOTAL $16.00 $273.50
3 MONTH 3 TOTAL $16.00 $273.50
4 If you get monthly MONTH 4 TOTAL $16.00 $273.50
5 refills at Walgreens, MONTH 5 TOTAL $16.00 $273.50
6 your annual costs in MONTH 6 TOTAL $16.00 $273.50
7 MONTH 7 TOTAL $16.00 $273.50
the AARP Medicare
8 MONTH 8 TOTAL $16.00 $273.50
Complete Choice
9 MONTH 9 TOTAL $16.00 $273.50
Plan 2 will be $192.
10 MONTH 10 TOTAL $16.00 $273.50
11 MONTH 11 TOTAL $16.00 $273.50
12 MONTH 12 TOTAL $16.00 $273.50

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