Representative out-of-pocket costs for Januvia under 6 representative Silver Marketplace plans (Dallas-Fort Worth Area)

1. Carrier Tier Pa)ent Cost-
Share
Subject to
Deduc)ble?
Plan Drug
Deduc)ble
Approximate
Annual Cost
A 2 $55 No N/A $700
B Not Covered $430 N/A N/A $5,100
C 3 $50 No N/A $600
D 4 $215 Yes $5,000* $3,900
E 4 $75 Yes $500 $1,300
F 4 $129 Yes $2,750* $1,900
Es>mated annual costs for Januvia for 6 representa>ve Silver plans
* Drug deduc*ble is included in plan deduc*ble