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B.Veletsis-Anthem MediBlue RX Plus (PDP) PDF
B.Veletsis-Anthem MediBlue RX Plus (PDP) PDF
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Total monthly premium Retail pharmacy: 2022 estimated total drug costs Mail order pharmacy: 2022 estimated total drug costs
Overview
PREMIUMS
DEDUCTIBLES
The amount you must pay each year before your plan starts to pay for covered services or drugs.
CONTACT INFORMATION
PHARMACIES
See the cost level to fill your drugs at the pharmacies you chose. You can also change pharmacies to see the cost level of other pharmacies in your area to find
the lowest cost pharmacy.
Drug costs shown vary based on the plan and pharmacy that you use. Contact the plan if you have specific questions about drug costs. Can my drug costs change
by pharmacy?
Atorvastatin 10mg
tablet $12.00 $12.00 $12.00 $24.00 $12.00
Estradiol 10mcg
tablet $2,239.44 $2,239.44 $2,239.44 $2,240.64 $2,234.60
Hydrochlorothiazide
/ triamterene 37.5- $12.00 $12.00 $12.00 $81.36 $12.00
25mg tablet
The drug prices shown may vary based on the plan and pharmacy you've selected. Contact the plan if you have specific questions about drug costs.
[1]
Estradiol 10mcg tablet $186.62 $186.62 $186.62 $186.62
[1]
This plan does not cover this drug, the price shown is the full cash price.
[1]
Estradiol 10mcg tablet $186.62 $186.62 $186.62 $186.62
[1]
This plan does not cover this drug, the price shown is the full cash price.
COSTCO PHARMACY #1115
[1]
Estradiol 10mcg tablet $186.62 $186.62 $186.62 $186.62
[1]
This plan does not cover this drug, the price shown is the full cash price.
WALGREENS #19804
[1]
Estradiol 10mcg tablet $186.72 $186.72 $186.72 $186.72
[1]
This plan does not cover this drug, the price shown is the full cash price.
MAIL ORDER PHARMACY
[1]
Estradiol 10mcg tablet $558.65 $558.65 $558.65 $558.65
[1]
This plan does not cover this drug, the price shown is the full cash price.
Plans group their drug lists into tiers. The drug costs below show how much you'll pay for drugs in each tier based on the coverage phase you're in.
PART B DRUGS
These are drugs you usually get at a doctor's office or hospital outpatient setting, like the flu shot, chemotherapy, or other shots.
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