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Learn about this plan's prescription drug coverage and costs. Enter your prescriptions to see what they'd cost with this plan.
| Costs | What you'll pay |
|---|---|
Annual Prescription Deductible
Annual Prescription Deductible
If your plan has an annual deductible, you (or others on your behalf) will pay your drug costs up to the amount of this deductible before moving into the Initial Coverage Stage.
$350 for Tiers 2-5 |
$0 for Tier 1 $350 for Tiers 2-5 |
|
Tier 1: Preferred Generic Drugs
Preferred Pharmacy Network Cost Sharing (30 days) $1 copay Standard Network Pharmacy Cost Sharing (30 days) $16 copay Preferred Mail Order Pharmacy (90 days) $3 copay Standard Mail Order Pharmacy (90 days) $48 copay |
Preferred Pharmacy Network Cost Sharing (30 days) $1 copay Standard Network Pharmacy Cost Sharing (30 days) $16 copay Preferred Mail Order Pharmacy (90 days) $3 copay Standard Mail Order Pharmacy (90 days) $48 copay |
|
Tier 2: Generic Drugs
Preferred Pharmacy Network Cost Sharing (30 days) $10 copay Standard Network Pharmacy Cost Sharing (30 days) $20 copay Preferred Mail Order Pharmacy (90 days) $30 copay Standard Mail Order Pharmacy (90 days) $60 copay |
Preferred Pharmacy Network Cost Sharing (30 days) $10 copay Standard Network Pharmacy Cost Sharing (30 days) $20 copay Preferred Mail Order Pharmacy (90 days) $30 copay Standard Mail Order Pharmacy (90 days) $60 copay |
|
Tier 3: Preferred Brand Drugs
Preferred Pharmacy Network Cost Sharing (30 days) $40 copay Standard Network Pharmacy Cost Sharing (30 days) $45 copay Preferred Mail Order Pharmacy (90 days) $120 copay Standard Mail Order Pharmacy (90 days) $135 copay |
Preferred Pharmacy Network Cost Sharing (30 days) $40 copay Standard Network Pharmacy Cost Sharing (30 days) $45 copay Preferred Mail Order Pharmacy (90 days) $120 copay Standard Mail Order Pharmacy (90 days) $135 copay |
|
Tier 3: Covered Insulin Drugs
Tier 3: Covered Insulin Drugs
For Chronic Special Needs Plans: You will pay a maximum of $25 for each 1-month supply of Part D select insulin drug through all coverage stages. For All Other Plans: You will pay a maximum of $35 for each 1-month supply of Part D covered insulin drug through all coverage stages. Cost Sharing (30 days) $35 copay Standard Network Pharmacy Cost Sharing (30 days) $35 copay Preferred Mail Order Pharmacy (90 days) $105 copay Standard Mail Order Pharmacy (90 days) $105 copay |
Preferred Pharmacy Network Cost Sharing (30 days) $35 copay Standard Network Pharmacy Cost Sharing (30 days) $35 copay Preferred Mail Order Pharmacy (90 days) $105 copay Standard Mail Order Pharmacy (90 days) $105 copay |
|
Tier 4: Non-Preferred Drugs
Preferred Pharmacy Network Cost Sharing (30 days) 45% of the cost Standard Network Pharmacy Cost Sharing (30 days) 50% of the cost Preferred Mail Order Pharmacy (90 days) 45% of the cost Standard Mail Order Pharmacy (90 days) 50% of the cost |
Preferred Pharmacy Network Cost Sharing (30 days) 45% of the cost Standard Network Pharmacy Cost Sharing (30 days) 50% of the cost Preferred Mail Order Pharmacy (90 days) 45% of the cost Standard Mail Order Pharmacy (90 days) 50% of the cost |
|
Tier 5: Specialty Tier Drugs
Preferred Pharmacy Network Cost Sharing (30 days) 27% of the cost Standard Network Pharmacy Cost Sharing (30 days) 27% of the cost |
Preferred Pharmacy Network Cost Sharing (30 days) 27% of the cost Standard Network Pharmacy Cost Sharing (30 days) 27% of the cost |
| Coverage Gap Stage 3 During the Coverage Gap Stage, you (or others on your behalf) will pay no more than 25% of the price for generic drugs or 25% of the price (plus the dispensing fee) for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $7,400 in year-to-date out-of-pocket costs. You may pay less if your plan has additional coverage in the gap. Always use your Medicare Prescription Drug plan member ID card during the coverage gap to get the plan's discounted drug rates. The money you spend using your card counts toward your out-of-pocket costs. | During the Coverage Gap Stage, you (or others on your behalf) will pay no more than 25% of the price for generic drugs or 25% of the price (plus the dispensing fee) for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $7,400 in year-to-date out-of-pocket costs. You may pay less if your plan has additional coverage in the gap. Always use your Medicare Prescription Drug plan member ID card during the coverage gap to get the plan's discounted drug rates. The money you spend using your card counts toward your out-of-pocket costs. |
| Catastrophic Coverage Stage After your total out-of-pocket costs reach $7,400, you will pay the greater of $4.15 copay for generic (including brand drugs treated as generic), and $10.35 copay for all other drugs, or 5% coinsurance. | After your total out-of-pocket costs reach $7,400, you will pay the greater of $4.15 copay for generic (including brand drugs treated as generic), and $10.35 copay for all other drugs, or 5% coinsurance. |
| Walgreens â Preferred Retail Pharmacy UnitedHealthcare and Walgreens are working together to offer you low prescription drug copays. There are more than 9,000 neighborhood Walgreens and Duane Reade locations nationwide. Save $15 or more on each prescription when you use Walgreens or Duane Reade. | UnitedHealthcare and Walgreens are working together to offer you low prescription drug copays. There are more than 9,000 neighborhood Walgreens and Duane Reade locations nationwide. Save $15 or more on each prescription when you use Walgreens or Duane Reade. |
Important documents that provide the details you need about this plan's coverage and benefits, prescription drugs, enrollment, providers and more.
| General Plan Information | |
| Prescription Drug Coverage | |
| Pharmacy Directory |
1 Your plan costs, including premiums and drug costs, may be different if you get⯠Extra Helpâ¯from the government or if you have Medicaid. For more information, see "Can I Get Help with my Medicare Prescription Drug Costs?"â¯
2 This document is the Annual Notice of Changes for this plan. If you are a current plan member and have been switched to a different plan, this document may not apply to you. If you have any questions, please call Customer Service at the number on your member ID card.â¯
3 During the Coverage Gap, amounts displayed for brand name drugs include a 70% manufacturer discount. However, this discount is based on pharmaceutical manufacturers' participation and may not apply to all brand drugs. You pay 25% of the total cost for brand name drugs, for any drug tier during the Coverage Gap.â¯
The 25% drug coinsurance within the Coverage Gap is based on an assessment that the drug is defined as a generic drug according to Part D rules.â¯
If your drug is not eligible for coverage under Medicare Part D, you will pay the full cost of the drug.â¯
Member may use any pharmacy in the network but may not receive the same pricing as Walgreens or Duane Reade, the plan's preferred retail pharmacies. Walgreens pharmacies may not be available in all areas. Duane Reade is only available in NY and NJ. Tier 2 copay, Tier 3 and Tier 4 coinsurance applies after deductible. $15 or more savings for the AARPâ¯MedicareRx Walgreens plan applies to Tier 1 drugs when filled at a Walgreens or Duane Reade preferred retail pharmacy compared to a standard network pharmacy.â¯
AARP MedicareRx Walgreens (PDP)âs pharmacy network includes limited lower-cost pharmacies in urban ND; suburban HI, ND, PA and rural AK, AR, HI, IA, ID, KS, MN, MT, NE, OK, PA, SD, and WY. There are an extremely limited number of preferred cost share pharmacies in suburban MT and rural ND. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call us or consult the online pharmacy directory.â¯
Member may use any pharmacy in the network but may not receive preferred retail pharmacy pricing. Pharmacies in the Preferred Retail Pharmacy Network may not be available in all areas. Copays apply after deductible. Note: The Preferred Retail Pharmacy Network is not available in Guam, American Samoa, U.S. Virgin Islands or Northern Mariana Islands.â¯
Pharmacy network includes limited lower-cost pharmacies in rural AK, MT, NE, ND, SD and WY. There are an extremely limited number of preferred cost share pharmacies in suburban MT. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use.â¯For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call us or⯠consult the online pharmacy directory.â¯
NOTE: If you are receiving Extra Help from Medicare, your copays may be lower or you may have no copays.â¯
Optum Mail Home Delivery:â¯
2023 Savings Benefitâ¯
Savings apply during the Initial Coverage period, which begins after the payment of your required deductible (if any) and ends when the total cost of your drugs (paid by UnitedHealthcare, you and others) reaches $4,660.â¯
NOTE: Optum Home Delivery is not available in Guam, American Samoa, U.S. Virgin Islands or Northern Mariana Islands.â¯
The list of covered drugs was last updated on 02/01/2023.â¯
NOTE:â¯Prescription drugs that are not covered by the plan or that cannot be provided as part of standard Medicare prescription drug coverage are shown as "not covered" in the chart.â¯
Copay or coinsurance amounts may change if you have⯠a limited income.â¯
The drug costs displayed are estimates and may vary based on the specific quantity, strength and/or dosage of the medication and the pharmacy you use.â¯It may be important to look beyond your current needs at the value of having Medicare prescription drug insurance. Enrolling when you become eligible will help give you peace of mind, should your drug needs become more significant in the future. It may also help you avoid the Medicare late enrollment penalty.â¯
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
The pharmacy directory is current as of the first Sunday of each month.â¯
All pharmacies may not be listed in this directory. Inclusion of a pharmacy does not guarantee that the pharmacy is open, is at the same location as listed in this online directory or is included in the network. The pharmacy network may change at any time. You will receive notice when necessary. Pharmacies on this list are called ânetwork pharmaciesâ because UnitedHealthcare has made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under your plan only if they are filled at a network pharmacy or through our mail order pharmacy service. You are not required to continue using the same pharmacy to fill your prescriptions and may switch to any other network pharmacy. Prescriptions can be filled at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and your planâs formulary. Please contactâ¯UnitedHealthcare for details.â¯
UnitedHealthcare has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area.â¯
Learn about prescription drug coverage determinations and appeals, prior authorization criteria, step therapy criteria and the 60-day formulary change notice. View prescription drug (Part D) coverage determinations and appeals process.â¯
View theâ¯UnitedHealthcare Prescription Drug Transition Process.â¯
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare-approved Part D sponsor. Enrollment in the plan depends on the planâs contract renewal with Medicare. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll. AARP encourages you to consider your needs when selecting products and does not make specific product or pharmacy recommendations for individuals. AARP MedicareRx Walgreens (PDP) plans: UnitedHealthcare contracts directly with Walgreens for this plan; AARP and its affiliates are not parties to that contractual relationship.â¯
This information is not a complete description of benefits. Call us⯠for more information.â¯
This information is available for free in other languages. Please⯠contactâ¯Customer Service for additional information.â¯
Esta información está disponible sin costo en otros idiomas. Para obtener más informaciónâ¯comunÃquese⯠con nuestro Servicio al Cliente.
Every year, Medicare evaluates plans based on a 5-star rating system.â¯
Get one-on-one help from UnitedHealthcare.
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