Page 77 - APPENDICES for Neill McLauchlin
P. 77
Time period Estimated monthly drug costs
December $84.45
Mail order pharmacy - Drug costs during coverage phases
Cost Cost in Cost after
Retail Cost after
Selected drugs before coverage coverage
cost deductible
deductible gap gap
Lisinopril 40mg tablet $17.99 $0.00 $0.00 $4.50 $3.70
Methimazole 5mg tablet $10.76 $0.00 $0.00 $2.69 $3.70
Propranolol hydrochloride 120mg
$139.48 $139.48 $107.50 $34.87 $6.97
capsule extended release 24 hour
Tolterodine tartrate 4mg capsule
$89.31 $89.31 $43.76 $22.33 $4.47
extended release 24 hour
Monthly totals $257.54 $228.79 $151.26 $64.39 $18.84
Estimated total drug + premium cost
You will pay $763.64 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 $228.79
July $228.79
