2017 AARP MedicareRx Walgreens (PDP) Formulary



Below is the Formulary, or drug list, for AARP MedicareRx Walgreens (PDP) from Unitedhealthcare Ins. Co. And Unitedhealthcare Ny This formulary is a list of prescription medications that are covered under Unitedhealthcare Ins. Co. And Unitedhealthcare Ny's 2017 Part-D Plan. The AARP MedicareRx Walgreens (PDP) plan has a $400 drug deductible. This deductible is the amount of expenses that must be paid out of pocket before the Initial Coverage period begins. However some drugs do not require that the deductible is met before you receive coverage. You can see if the deductible is required below in the "Does the Deductible Apply" column. The Initial Coverage Limit (ICL) for this plan is $3700. The Initial Coverage Period is the period after the Deductible has been met but before the Coverage Gap phase. Once you and your plan provider have spent $3700 on covered drugs. (combined amount plus your deductible) You will enter the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will be required to pay 45% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. You can see if this plan offers coverage in the "donut hole" be clicking the "Coverage Gap" link on the left above the chart. In 2017 if you have spent $4700 in expenditures you enter the Catastrophic Phase. During the Catastrophic Period you will begin to receive significant coverage. AARP MedicareRx Walgreens (PDP) will begin paying approximately 95% of your covered medication expenses. You can see if this plan covers your drugs in the Catastrophic Phase by clicking the "Catastrophic" link on the left above the chart.

See More on AARP MedicareRx Walgreens (PDP)





Plan Name:
AARP MedicareRx Walgreens (PDP)
Plan ID:
S5921-383
Provider: Unitedhealthcare Ins. Co. And Unitedhealthcare Ny
Plan Year:2017
Premium:$22.50
Deductible:$400
Initial Coverage Limit:$3700
Coverage Area:Florida




Current Table info:


Coverage Level:
Initial Coverage
Days Supply:
30 Days
Drugs Starting With Letter: F

Change Table Options:


Drugs Starting Letter:
A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S T  U  V  W  X  Y  Z 
Coverage Level:
Drug Days Pricing:60 Day
90 Day











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(Click the Drug Name to Compare every Plans Price)

Drug Name Drug Strength Units in Package Tier Level Amount Limit Days Limit Prior Authorization
Y/N
Step Therapy
Y/N
Does the Deduct Apply Cost Preferred Max Cost Non Preferred Max Cost Mail Max
Fabrazyme 5mg/mL 1 Ml In 1 Vial, Glass
5
N N Y 25%N25%NNAN
Falmina 1 Blister Pack In 1 Packet > 1 Kit In 1 Blister Pack
4
N N Y 32%N33%NNAN
Famciclovir 125mg 30 Tablet, Film Coated In 1 Bottle
3
60 30 N N Y $27N$47NNAN
Famciclovir 250mg 30 Tablet, Film Coated In 1 Bottle
3
60 30 N N Y $27N$47NNAN
Famciclovir 500mg 30 Tablet, Film Coated In 1 Bottle
3
90 30 N N Y $27N$47NNAN
Famotidine 20mg/50mL 12 Bag In 1 Carton > 50 Ml In 1 Bag
4
N N Y 32%N33%NNAN
Famotidine 20mg 500 Tablet, Film Coated In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Famotidine 40mg 100 Tablet, Film Coated In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Famotidine 10mg/mL 25 Vial, Single-dose In 1 Tray > 2 Ml In 1 Vial, Single-dose
4
N N Y 32%N33%NNAN
Fanapt 1mg 60 Tablet In 1 Bottle
4
60 30 N Y Y 32%N33%NNAN
Fanapt 2mg 60 Tablet In 1 Bottle
4
60 30 N Y Y 32%N33%NNAN
Fanapt 6mg 60 Tablet In 1 Bottle
4
60 30 N Y Y 32%N33%NNAN
Fanapt 12mg 60 Tablet In 1 Bottle
4
60 30 N Y Y 32%N33%NNAN
Fanapt 60 Tablet In 1 Bottle
4
60 30 N Y Y 32%N33%NNAN
Fanapt 60 Tablet In 1 Bottle
4
60 30 N Y Y 32%N33%NNAN
Fanapt 60 Tablet In 1 Bottle
4
60 30 N Y Y 32%N33%NNAN
Fanapt 1 Blister Pack In 1 Dose Pack > 1 Kit In 1 Blister Pack
4
N Y Y 32%N33%NNAN
Fareston 60mg 30 Tablet In 1 Bottle
5
N N Y 25%N25%NNAN
Faslodex 50mg/mL 2 Syringe, Glass In 1 Carton > 5 Ml In 1 Syringe, Glass
5
N N Y 25%N25%NNAN
Felbamate 600mg/5mL 473 Ml In 1 Bottle
5
N N Y 25%N25%NNAN
Felbamate 400mg 30 Tablet In 1 Bottle
4
N N Y 32%N33%NNAN
Felbamate 600mg 90 Tablet In 1 Bottle
4
N N Y 32%N33%NNAN
Fenofibrate 54mg 90 Tablet In 1 Bottle
2
N N N $3N$18NNAN
Fenofibrate 160mg 90 Tablet In 1 Bottle
2
N N N $3N$18NNAN
Fentanyl 12ug/h 5 Pouch In 1 Carton > 72 H In 1 Patch
3
15 30 N N Y $27N$47NNAN
Fentanyl 100ug/h 5 Pouch In 1 Carton > 72 H In 1 Patch
3
15 30 N N Y $27N$47NNAN
Fentanyl 25ug/h 5 Pouch In 1 Carton > 72 H In 1 Patch
3
15 30 N N Y $27N$47NNAN
Fentanyl 50ug/h 5 Pouch In 1 Carton > 72 H In 1 Patch
3
15 30 N N Y $27N$47NNAN
Fentanyl 75ug/h 5 Pouch In 1 Carton > 72 H In 1 Patch
3
15 30 N N Y $27N$47NNAN
Ferriprox 500mg 100 Tablet, Film Coated In 1 Bottle, Plastic
5
Y N Y 25%N25%NNAN
Fetzima 1 Kit In 1 Blister Pack
4
N Y Y 32%N33%NNAN
Fetzima 120mg 30 Capsule, Extended Release In 1 Bottle, Plastic
4
30 30 N Y Y 32%N33%NNAN
Fetzima 20mg 30 Capsule, Extended Release In 1 Bottle, Plastic
4
30 30 N Y Y 32%N33%NNAN
Fetzima 40mg 30 Capsule, Extended Release In 1 Bottle, Plastic
4
30 30 N Y Y 32%N33%NNAN
Fetzima 80mg 30 Capsule, Extended Release In 1 Bottle, Plastic
4
30 30 N Y Y 32%N33%NNAN
Finasteride 90 Tablet, Film Coated In 1 Bottle
2
N N N $3N$18NNAN
Firazyr 30mg/3mL 1 Syringe, Glass In 1 Carton > 3 Ml In 1 Syringe, Glass
5
270 30 Y N Y 25%N25%NNAN
Firmagon 1 Kit In 1 Carton * 4 Ml In 1 Vial, Glass * 4.2 Ml In 1 Syringe
4
Y N Y 32%N33%NNAN
Firmagon 1 Kit In 1 Carton * 3 Ml In 1 Vial, Glass * 3 Ml In 1 Syringe
5
Y N Y 25%N25%NNAN
Flebogamma Dif 1 Vial In 1 Carton
4
Y N Y 32%N33%NNAN
Flecainide Acetate 100mg 60 Tablet In 1 Bottle
2
N N N $3N$18NNAN
Flecainide Acetate 150mg 60 Tablet In 1 Bottle
2
N N N $3N$18NNAN
Flecainide Acetate 50mg 100 Tablet In 1 Bottle
2
N N N $3N$18NNAN
Flector 180mg 6 Pouch In 1 Carton
4
60 30 Y N Y 32%N33%NNAN
Fluconazole 10mg/mL 350 Ml In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Fluconazole 40mg/mL 1400 Ml In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Fluconazole 50mg 30 Tablet In 1 Bottle
2
N N N $3N$18NNAN
Fluconazole 100mg 30 Tablet In 1 Bottle
2
N N N $3N$18NNAN
Fluconazole 150mg 12 Blister Pack In 1 Box
2
N N N $3N$18NNAN
Fluconazole 200mg 30 Tablet In 1 Bottle
2
N N N $3N$18NNAN
Fluconazole 6 Bag In 1 Carton > 200 Ml In 1 Bag
4
N N Y 32%N33%NNAN
Fluconazole 24 Bag In 1 Case > 100 Ml In 1 Bag
4
N N Y 32%N33%NNAN
Flucytosine 250mg 100 Capsule In 1 Bottle
5
N N Y 25%N25%NNAN
Flucytosine 500mg 100 Capsule In 1 Bottle
5
N N Y 25%N25%NNAN
Fludarabine Phosphate 50mg/2mL 1 Vial, Single-dose In 1 Carton > 2 Ml In 1 Vial, Single-dose
4
N N Y 32%N33%NNAN
Fludrocortisone Acetate .1mg 100 Tablet In 1 Bottle
2
N N N $3N$18NNAN
Flunisolide .25mg/mL 1 Bottle, Pump In 1 Carton > 25 Ml In 1 Bottle, Pump
3
N N Y $27N$47NNAN
Fluocinolone Acetonide .1mg/g 60 G In 1 Tube
3
N N Y $27N$47NNAN
Fluocinolone Acetonide .1mg/mL 60 Ml In 1 Bottle
4
N N Y 32%N33%NNAN
Fluocinolone Acetonide .25mg/g 60 G In 1 Tube
3
N N Y $27N$47NNAN
Fluocinolone Acetonide .25mg/g 60 G In 1 Tube
3
N N Y $27N$47NNAN
Fluocinolone Acetonide .11mg/20mL 1 Bottle In 1 Carton > 20 Ml In 1 Bottle
4
N N Y 32%N33%NNAN
Fluocinonide .5mg/mL 1 Bottle In 1 Carton > 60 Ml In 1 Bottle
3
N N Y $27N$47NNAN
Fluocinonide .5mg/g 1 Tube In 1 Carton > 60 G In 1 Tube
3
N N Y $27N$47NNAN
Fluocinonide .5mg/g 1 Tube In 1 Carton > 30 G In 1 Tube
3
N N Y $27N$47NNAN
Fluocinonide .5mg/g 1 Tube In 1 Carton > 60 G In 1 Tube
3
N N Y $27N$47NNAN
Fluorometholone 1 Bottle, Dropper In 1 Carton > 5 Ml In 1 Bottle, Dropper
3
N N Y $27N$47NNAN
Fluorouracil 20mg/mL 1 Bottle In 1 Carton > 10 Ml In 1 Bottle
3
N N Y $27N$47NNAN
Fluorouracil 50mg/mL 1 Bottle In 1 Carton > 10 Ml In 1 Bottle
3
N N Y $27N$47NNAN
Fluorouracil 50mg/mL 1 Vial, Pharmacy Bulk Package In 1 Carton > 50 Ml In 1 Vial, Pharmacy Bulk Package
4
Y N Y 32%N33%NNAN
Fluorouracil 50mg/g 40 G In 1 Tube
4
N N Y 32%N33%NNAN
Fluoxetine 10mg 100 Capsule In 1 Bottle
2
N N N $3N$18NNAN
Fluoxetine 20mg/5mL 120 Ml In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Fluoxetine 40mg 30 Capsule In 1 Bottle
2
N N N $3N$18NNAN
Fluoxetine Hydrochloride 20mg 100 Capsule In 1 Bottle
2
N N N $3N$18NNAN
Fluphenazine Decanoate 25mg/mL 1 Vial In 1 Carton > 5 Ml In 1 Vial
4
N N Y 32%N33%NNAN
Fluphenazine Hydrochloride 5mg/mL 120 Ml In 1 Bottle, Dropper
3
N N Y $27N$47NNAN
Fluphenazine Hydrochloride .5mg/mL 473 Ml In 1 Bottle
4
N N Y 32%N33%NNAN
Fluphenazine Hydrochloride 1mg 500 Tablet, Film Coated In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Fluphenazine Hydrochloride 5mg 500 Tablet, Film Coated In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Fluphenazine Hydrochloride 10mg 500 Tablet, Film Coated In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Fluphenazine Hydrochloride 2.5mg 100 Tablet, Film Coated In 1 Bottle
2
N N N $3N$18NNAN
Fluphenazine Hydrochloride 2.5mg/mL 1 Vial In 1 Box > 10 Ml In 1 Vial
4
N N Y 32%N33%NNAN
Flurbiprofen Sodium .3mg/mL 1 Bottle, Dropper In 1 Carton > 2.5 Ml In 1 Bottle, Dropper
2
N N N $3N$18NNAN
Flutamide 125mg 500 Capsule In 1 Bottle
3
N N Y $27N$47NNAN
Fluticasone Propionate 50ug 1 Bottle, Glass In 1 Carton > 120 Spray, Metered In 1 Bottle, Glass
2
N N N $3N$18NNAN
Fluticasone Propionate .05mg/g 1 Tube In 1 Carton > 30 G In 1 Tube
3
N N Y $27N$47NNAN
Fluticasone Propionate .5mg/g 1 Tube In 1 Carton > 30 G In 1 Tube
3
N N Y $27N$47NNAN
Fluvoxamine Maleate 50mg 100 Tablet, Film Coated In 1 Bottle
3
N N Y $27N$47NNAN
Fluvoxamine Maleate 100mg 500 Tablet, Film Coated In 1 Bottle
3
N N Y $27N$47NNAN
Fluvoxamine Maleate 25mg 100 Tablet, Film Coated In 1 Bottle, Plastic
3
N N Y $27N$47NNAN
Folotyn 20mg/mL 1 Vial, Single-use In 1 Carton > 2 Ml In 1 Vial, Single-use
5
N N Y 25%N25%NNAN
Fomepizole 1g/mL 1 Vial In 1 Carton > 1.5 Ml In 1 Vial
5
N N Y 25%N25%NNAN
Fondaparinux Sodium 2.5mg/.5mL 2 Syringe In 1 Carton
4
N N Y 32%N33%NNAN
Fondaparinux Sodium 5mg/.4mL 2 Syringe In 1 Carton
4
N N Y 32%N33%NNAN
Fondaparinux Sodium 7.5mg/.6mL 2 Syringe In 1 Carton
4
N N Y 32%N33%NNAN
Fondaparinux Sodium 10mg/.8mL 2 Syringe In 1 Carton
4
N N Y 32%N33%NNAN
Forteo 250ug/mL 1 Syringe In 1 Carton > 2.4 Ml In 1 Syringe
5
2.40 28 Y N Y 25%N25%NNAN
Fosinopril Sodium 10mg 90 Tablet In 1 Bottle
2
60 30 N N N $3N$18NNAN
Fosinopril Sodium 90 Tablet In 1 Bottle
2
60 30 N N N $3N$18NNAN
Fosinopril Sodium 90 Tablet In 1 Bottle
2
60 30 N N N $3N$18NNAN
Fosphenytoin Sodium 50mg/mL 2 Ml In 1 Vial
4
N N Y 32%N33%NNAN
Fosrenol 500mg 2 Bottle In 1 Package
4
N N Y 32%N33%NNAN
Fosrenol 750mg 6 Bottle In 1 Package
4
N N Y 32%N33%NNAN
Fosrenol 1000mg 9 Bottle In 1 Package
4
N N Y 32%N33%NNAN
Fosrenol 9 Carton In 1 Package > 10 Powder In 1 Carton
4
N N Y 32%N33%NNAN
Fosrenol 9 Carton In 1 Carton > 10 Powder In 1 Carton
4
N N Y 32%N33%NNAN
Freamine Hbc 6 Carton In 1 Case > 1 Container In 1 Carton > 750 Ml In 1 Container
4
Y N Y 32%N33%NNAN
Furosemide 10mg/mL 120 Ml In 1 Bottle, Dropper
1
N N N $0N$15NNAN
Furosemide 40mg/5mL 500 Ml In 1 Bottle, Plastic
1
N N N $0N$15NNAN
Furosemide 25 Vial, Glass In 1 Tray > 10 Ml In 1 Vial, Glass
4
Y N Y 32%N33%NNAN
Furosemide 10 Carton In 1 Container > 1 Syringe, Plastic In 1 Carton > 4 Ml In 1 Syringe, Plastic
4
Y N Y 32%N33%NNAN
Furosemide 40mg 5000 Tablet In 1 Bottle, Plastic
1
N N N $0N$15NNAN
Furosemide 80mg 500 Tablet In 1 Bottle, Plastic
1
N N N $0N$15NNAN
Furosemide 20mg 100 Tablet In 1 Bottle
1
N N N $0N$15NNAN
Fusilev 50mg/5mL 1 Vial In 1 Carton > 5 Ml In 1 Vial
5
N N Y 25%N25%NNAN
Fuzeon 1 Kit In 1 Carton * 1 Ml In 1 Vial, Single-use * 1 Ml In 1 Vial, Single-dose
5
90 30 N N Y 25%N25%NNAN
Fycompa 2mg 30 Tablet In 1 Bottle
4
N N Y 32%N33%NNAN
Fycompa 4mg 30 Tablet In 1 Bottle
4
N N Y 32%N33%NNAN
Fycompa 6mg 30 Tablet In 1 Bottle
4
N N Y 32%N33%NNAN
Fycompa 8mg 30 Tablet In 1 Bottle
4
N N Y 32%N33%NNAN
Fycompa 10mg 30 Tablet In 1 Bottle
4
N N Y 32%N33%NNAN
Fycompa 12mg 30 Tablet In 1 Bottle
4
N N Y 32%N33%NNAN



Medicare Help's Additional Notes:

Coverage Levels for S5921-383

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1.Pre-Deductable: Before you reach the plans deductible of $400. Some plans offer select Pre-deductible drug Coverage
2.Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit of $3700
3.Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $4950 in 2017.
4.Catastrophic: Anything over $4950 you will receive a significant increase in coverage.

Definitions:

Premium: A monthly flat fee that varies by plan.
Deductible: The amount you must pay each year for your prescriptions before your plan begins to pay its share of your covered drugs. The max in 2017 is $320. Some plans have a $0 Deductible.
Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less.
Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. That means the plan will only cover the drug up to a designated quantity or amount. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered.
Prior Authorization: Certain Drugs require you or your doctor to get prior authorization in order to be covered. Usually just an additional form. If you dont get approval, the plan may not cover the drug.
Does the Deduct Apply: Some drugs do not require that the deductible is met before you receive coverage.
Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.
Cost Prefered: Your Cost for the Drug at the Providers In Network Prefered Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Non Pref: Your Cost for the Prescription Drug at a Non-Prefered Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. As a Percent of the total drug cost or a flat rate.


What if a drug I need is not listed?

Please check the formulary for different brand and generic names. If you still cannot locate your drugs, your plan may not offer coverage. Talk to your doctor first about changing your prescription to a drug on your plans formulary. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances.

Source:CMS Formulary Data Oct. 2016
Source:NDC Directory by FDA.gov

**We make every attempt to keep our information accurate. But please check with the plan providers to verify all information.

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