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: G

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
Gabapentin 600mg 100 Tablet, Film Coated In 1 Bottle
2
N N N $3N$18NNAN
Gabapentin 250mg/5mL 470 Ml In 1 Bottle
2
N N N $3N$18NNAN
Gabapentin 400mg 100 Capsule In 1 Bottle
2
N N N $3N$18NNAN
Gabapentin 300mg 100 Capsule In 1 Bottle
2
N N N $3N$18NNAN
Gabapentin 600mg 500 Tablet, Film Coated In 1 Bottle
2
N N N $3N$18NNAN
Gabapentin 100mg 100 Capsule In 1 Bottle
2
N N N $3N$18NNAN
Gabitril 12mg 30 Tablet In 1 Bottle
4
120 30 N N Y 32%N33%NNAN
Gabitril 16mg 30 Tablet In 1 Bottle
4
90 30 N N Y 32%N33%NNAN
Gablofen 50ug/mL 1 Ml In 1 Syringe, Glass
4
Y N Y 32%N33%NNAN
Gablofen 500ug/mL 20 Ml In 1 Vial, Glass
4
Y N Y 32%N33%NNAN
Gablofen 2000ug/mL 20 Ml In 1 Vial, Glass
4
Y N Y 32%N33%NNAN
Gamastan S/d .165g/mL 1 Vial In 1 Carton
3
Y N Y $27N$47NNAN
Gammagard Liquid 100mg/mL 1 Bottle, Glass In 1 Carton > 25 Ml In 1 Bottle, Glass
4
Y N Y 32%N33%NNAN
Gammaked 1 Vial, Glass In 1 Carton
4
Y N Y 32%N33%NNAN
Ganciclovir 500mg/10mL 25 Vial In 1 Tray > 10 Ml In 1 Vial
3
Y N Y $27N$47NNAN
Gardasil 40; 40; 20; 20ug/.5mL; ug/.5mL; ug/.5mL; ug/.5mL 1 Vial, Single-dose In 1 Carton
3
N N Y $27N$47NNAN
Gardasil 10 Syringe In 1 Carton
3
N N Y $27N$47NNAN
Gattex 1 Kit In 1 Carton * 1 Injection, Powder, Lyophilized, For Solution In 1 Vial, Glass * 1 Solution In 1 Syringe, Plastic
5
Y N Y 25%N25%NNAN
Gavilyte - C 240; 2.98; 6.72; 5.84; 22.72g/278.26g; g/278.26g; g/278.26g; g/278.26g; g/278. 278.26 G In 1 Bottle
2
N N N $3N$18NNAN
Gavilyte - N 420; 1.48; 5.72; 11.2g/438.4g; g/438.4g; g/438.4g; g/438.4g 438.4 G In 1 Bottle
2
N N N $3N$18NNAN
Gavilyte G 236; 2.97; 6.74; 5.86; 22.74g/274.31g; g/274.31g; g/274.31g; g/274.31g; g/274. 274.31 G In 1 Bottle
2
N N N $3N$18NNAN
Gemcitabine Hydrochloride 1g/25mL 1 Vial In 1 Carton > 25 Ml In 1 Vial
4
N N Y 32%N33%NNAN
Gemfibrozil 600mg 500 Tablet, Film Coated In 1 Bottle
2
N N N $3N$18NNAN
Generlac 10g/15mL 1892 Ml In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Gengraf 100mg/mL 1 Bottle In 1 Carton > 50 Ml In 1 Bottle
3
Y N Y $27N$47NNAN
Genotropin 1 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
5
Y N Y 25%N25%NNAN
Genotropin 1 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
5
Y N Y 25%N25%NNAN
Genotropin 7 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
4
Y N Y 32%N33%NNAN
Genotropin 7 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
5
Y N Y 25%N25%NNAN
Genotropin 7 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
5
Y N Y 25%N25%NNAN
Genotropin 7 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
5
Y N Y 25%N25%NNAN
Genotropin 7 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
5
Y N Y 25%N25%NNAN
Genotropin 7 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
5
Y N Y 25%N25%NNAN
Genotropin 7 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
5
Y N Y 25%N25%NNAN
Genotropin 7 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
5
Y N Y 25%N25%NNAN
Genotropin 7 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
5
Y N Y 25%N25%NNAN
Genotropin 7 Cartridge In 1 Carton > 1 Kit In 1 Cartridge
5
Y N Y 25%N25%NNAN
Gentak 3mg/g 1 Tube In 1 Carton > 3.5 G In 1 Tube
2
N N N $3N$18NNAN
Gentamicin Sulfate 40mg/mL 25 Vial, Single-dose In 1 Tray > 2 Ml In 1 Vial, Single-dose
4
N N Y 32%N33%NNAN
Gentamicin Sulfate 10mg/mL 25 Vial, Patent Delivery System In 1 Tray > 8 Ml In 1 Vial, Patent Delivery System
4
N N Y 32%N33%NNAN
Gentamicin Sulfate 3mg/g 1 Tube In 1 Carton > 3.5 G In 1 Tube
2
N N N $3N$18NNAN
Gentamicin Sulfate 3mg/mL 1 Bottle, Dropper In 1 Carton > 5 Ml In 1 Bottle, Dropper
2
N N N $3N$18NNAN
Gentamicin Sulfate 1mg/g 1 Tube In 1 Carton > 15 G In 1 Tube
2
N N N $3N$18NNAN
Gentamicin Sulfate 1mg/g 1 Tube In 1 Carton > 15 G In 1 Tube
2
N N N $3N$18NNAN
Gentamicin Sulfate In Sodium Chloride 80mg/100mL 100 Ml In 1 Bag
4
N N Y 32%N33%NNAN
Gentamicin Sulfate In Sodium Chloride 100 Ml In 1 Bag
4
N N Y 32%N33%NNAN
Gentamicin Sulfate In Sodium Chloride 60mg/50mL 50 Ml In 1 Bag
4
N N Y 32%N33%NNAN
Gentamicin Sulfate In Sodium Chloride 50 Ml In 1 Bag
4
N N Y 32%N33%NNAN
Geodon 20mg/mL 10 Vial, Single-dose In 1 Carton
4
N N Y 32%N33%NNAN
Gianvi 3 Blister Pack In 1 Package
4
N N Y 32%N33%NNAN
Gildagia 6 Blister Pack In 1 Carton
4
N N Y 32%N33%NNAN
Gilotrif 30mg 1 Bottle In 1 Carton > 30 Tablet, Film Coated In 1 Bottle
5
Y N Y 25%N25%NNAN
Gilotrif 40mg 1 Bottle In 1 Carton > 30 Tablet, Film Coated In 1 Bottle
5
Y N Y 25%N25%NNAN
Gilotrif 20mg 1 Bottle In 1 Carton > 30 Tablet, Film Coated In 1 Bottle
5
Y N Y 25%N25%NNAN
Gleostine 1 Bottle In 1 Carton > 5 Capsule, Gelatin Coated In 1 Bottle
4
N N Y 32%N33%NNAN
Gleostine 1 Bottle In 1 Carton > 5 Capsule, Gelatin Coated In 1 Bottle
4
N N Y 32%N33%NNAN
Gleostine 1 Bottle In 1 Carton > 5 Capsule, Gelatin Coated In 1 Bottle
4
N N Y 32%N33%NNAN
Glimepiride 1mg 100 Tablet In 1 Bottle
1
240 30 N N N $0N$15NNAN
Glimepiride 2mg 100 Tablet In 1 Bottle
1
120 30 N N N $0N$15NNAN
Glimepiride 4mg 100 Tablet In 1 Bottle
1
60 30 N N N $0N$15NNAN
Glipizide 10mg 100 Tablet In 1 Bottle, Plastic
1
120 30 N N N $0N$15NNAN
Glipizide 5mg 100 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic
1
120 30 N N N $0N$15NNAN
Glipizide 10mg 100 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic
1
60 30 N N N $0N$15NNAN
Glipizide 2.5mg 30 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic
1
240 30 N N N $0N$15NNAN
Glipizide 5mg 500 Tablet In 1 Bottle
1
240 30 N N N $0N$15NNAN
Glipizide And Metformin Hydrochloride 2.5; 500mg/1; mg 100 Tablet, Film Coated In 1 Bottle
1
120 30 N N N $0N$15NNAN
Glipizide And Metformin Hydrochloride 5; 500mg/1; mg 100 Tablet, Film Coated In 1 Bottle
1
120 30 N N N $0N$15NNAN
Glipizide And Metformin Hydrochloride 2.5; 250mg/1; mg 100 Tablet, Film Coated In 1 Bottle, Plastic
1
240 30 N N N $0N$15NNAN
Glucagen Hypokit 1 Kit In 1 Kit * 1 Ml In 1 Vial, Glass * 1 Ml In 1 Syringe, Glass
4
N N Y 32%N33%NNAN
Glucagon 1 Kit In 1 Kit
3
N N Y $27N$47NNAN
Glycopyrrolate .2mg/mL 25 Vial, Multi-dose In 1 Tray > 20 Ml In 1 Vial, Multi-dose
4
N N Y 32%N33%NNAN
Granisetron .1mg/mL 10 Vial, Single-use In 1 Tray > 1 Ml In 1 Vial, Single-use
4
N N Y 32%N33%NNAN
Granisetron 1 Vial In 1 Box > 4 Ml In 1 Vial
4
N N Y 32%N33%NNAN
Granisetron Hydrochloride 2 Tablet In 1 Bottle
4
60 30 Y N Y 32%N33%NNAN
Granisetron Hydrochloride 1mg/mL 10 Vial, Single-use In 1 Package
4
N N Y 32%N33%NNAN
Griseofulvin 125mg/5mL 120 Ml In 1 Bottle
4
N N Y 32%N33%NNAN
Griseofulvin 125mg 100 Tablet In 1 Bottle
4
N N Y 32%N33%NNAN
Griseofulvin 250mg 100 Tablet In 1 Bottle
4
N N Y 32%N33%NNAN
Griseofulvin 500mg 100 Tablet In 1 Bottle
4
N N Y 32%N33%NNAN
Guanfacine 2mg 100 Tablet In 1 Bottle
2
N N N $3N$18NNAN
Guanfacine 1mg 100 Tablet In 1 Bottle, Plastic
2
60 30 N N N $3N$18NNAN
Guanidine Hydrochloride 125mg 100 Tablet In 1 Bottle
3
N N Y $27N$47NNAN



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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