Page 76 - APPENDICES for Neill McLauchlin

C o s t C o s t i n Cost after
o
s
Cost in
Cost
C
t
t
e
r

a
f
Cost after
R e t a i l C o s t a f t e r
Retail
r
b
e
f
o
e
g
a
coverage
e
r
o
c
e
v
Selected drugs
S e l e c t e d d r u g s before coverage c o v e r a g e
u
c
d
d
e
l
e
b
t
i
cost
c o s t deductible
d
deductible g a p gap
d
e
gap
g
p
a
b
l
e
c
t
i
u
Lisinopril 40mg tablet $5.32 $5.00 $5.00 $1.33 $3.70
Methimazole 5mg tablet $2.99 $2.99 $2.99 $0.75 $2.99
Propranolol hydrochloride 120mg
$61.60 $61.60 $47.00 $15.40 $3.70
capsule extended release 24 hour
Tolterodine tartrate 4mg capsule
$58.92 $58.92 $29.46 $14.73 $3.70
extended release 24 hour
Monthly totals $128.83 $128.51 $84.45 $32.21 $14.09
Estimated total drug + premium cost
You will pay $1,091.09 per year on drug + premium costs.
Based on current drug costs, it's estimated that:
You'll meet your $445.00 deductible in July
You won't enter the coverage gap this year
Estimated monthly drug costs
This doesn't include your monthly plan premium of $17.20.
View the costs of your drugs every month
Time period Estimated monthly drug costs
April $128.51
May $128.51 Seven-month costs =
$887.79 (includes
June $128.51 monthly premiums
of $17.20)
July $128.51
August $84.45
September $84.45

October $84.45

November $84.45