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: R

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
Raloxifene Hydrochloride 60mg 100 Tablet, Film Coated In 1 Bottle
2
30 30 N N N $3N$18NNAN
Ramipril 1.25mg 30 Capsule In 1 Bottle, Plastic
2
60 30 N N N $3N$18NNAN
Ramipril 2.5mg 100 Capsule In 1 Bottle, Plastic
2
60 30 N N N $3N$18NNAN
Ramipril 5mg 100 Capsule In 1 Bottle, Plastic
2
60 30 N N N $3N$18NNAN
Ramipril 10mg 100 Capsule In 1 Bottle, Plastic
2
60 30 N N N $3N$18NNAN
Ranexa 500mg 60 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic
3
60 30 N N Y $27N$47NNAN
Ranexa 1000mg 60 Tablet, Film Coated, Extended Release In 1 Bottle, Plastic
3
60 30 N N Y $27N$47NNAN
Ranitidine 300mg 100 Tablet, Film Coated In 1 Bottle
2
N N N $3N$18NNAN
Ranitidine Hydrochloride 1000 Tablet, Film Coated In 1 Bottle
2
N N N $3N$18NNAN
Ranitidine Hydrochloride 25mg/mL 6 Ml In 1 Vial, Multi-dose
4
N N Y 32%N33%NNAN
Rapaflo 4mg 30 Capsule In 1 Bottle, Unit-dose
3
30 30 N N Y $27N$47NNAN
Rapaflo 8mg 90 Capsule In 1 Bottle, Unit-dose
3
30 30 N N Y $27N$47NNAN
Rapamune 1mg/mL 1 Carton In 1 Kit > 60 Ml In 1 Bottle, Glass
5
Y N Y 25%N25%NNAN
Rebif 22ug/.5mL 12 Syringe, Glass In 1 Carton > .5 Ml In 1 Syringe, Glass
5
Y N Y 25%N25%NNAN
Rebif 44ug/.5mL 12 Syringe, Glass In 1 Carton > .5 Ml In 1 Syringe, Glass
5
Y N Y 25%N25%NNAN
Rebif 1 Kit In 1 Carton * .2 Ml In 1 Syringe, Glass * .5 Ml In 1 Syringe, Glass
5
Y N Y 25%N25%NNAN
Rebif Rebidose 1 Kit In 1 Carton * .2 Ml In 1 Package * .5 Ml In 1 Package
5
Y N Y 25%N25%NNAN
Rebif Rebidose 12 Package In 1 Carton
5
Y N Y 25%N25%NNAN
Rebif Rebidose 12 Package In 1 Carton
5
Y N Y 25%N25%NNAN
Reclipsen 6 Blister Pack In 1 Carton > 1 Kit In 1 Blister Pack
4
N N Y 32%N33%NNAN
Recombivax Hb 10 Syringe In 1 Carton
3
Y N Y $27N$47NNAN
Recombivax Hb 40ug/mL 1 Vial, Single-dose In 1 Carton
3
Y N Y $27N$47NNAN
Recombivax Hb 10ug/mL 1 Vial, Single-dose In 1 Carton
3
Y N Y $27N$47NNAN
Relenza 5mg 5 Package In 1 Carton > 4 Powder In 1 Package
3
60 30 N N Y $27N$47NNAN
Relistor 1 Vial, Single-dose In 1 Carton > .6 Ml In 1 Vial, Single-dose
4
Y N Y 32%N33%NNAN
Relistor 7 Blister Pack In 1 Carton > 1 Syringe In 1 Blister Pack > .6 Ml In 1 Syringe
4
Y N Y 32%N33%NNAN
Relistor 7 Blister Pack In 1 Carton > 1 Syringe In 1 Blister Pack > .4 Ml In 1 Syringe
4
Y N Y 32%N33%NNAN
Remicade 100mg/10mL 10 Vial, Single-use In 1 Box > 10 Ml In 1 Vial, Single-use
5
Y N Y 25%N25%NNAN
Remodulin 20mg/20mL 1 Vial In 1 Box > 20 Ml In 1 Vial
5
Y N Y 25%N25%NNAN
Remodulin 50mg/20mL 1 Vial In 1 Box > 20 Ml In 1 Vial
5
Y N Y 25%N25%NNAN
Remodulin 100mg/20mL 1 Vial In 1 Box > 20 Ml In 1 Vial
5
Y N Y 25%N25%NNAN
Remodulin 200mg/20mL 1 Vial In 1 Box > 20 Ml In 1 Vial
5
Y N Y 25%N25%NNAN
Renvela 800mg 270 Tablet, Film Coated In 1 Bottle
3
N N Y $27N$47NNAN
Renvela 2400mg 90 Packet In 1 Carton
3
N N Y $27N$47NNAN
Renvela 800mg 90 Packet In 1 Carton
3
N N Y $27N$47NNAN
Repaglinide .5mg 100 Tablet In 1 Bottle
4
960 30 N N Y 32%N33%NNAN
Repaglinide 1mg 500 Tablet In 1 Bottle
4
480 30 N N Y 32%N33%NNAN
Repaglinide 2mg 500 Tablet In 1 Bottle
4
240 30 N N Y 32%N33%NNAN
Rescriptor 100mg 360 Tablet In 1 Bottle
4
270 30 N N Y 32%N33%NNAN
Rescriptor 200mg 180 Tablet In 1 Bottle
4
270 30 N N Y 32%N33%NNAN
Restasis .5mg/mL 30 Vial, Single-use In 1 Tray > .4 Ml In 1 Vial, Single-use
3
60 30 N N Y $27N$47NNAN
Retrovir 10mg/mL 10 Vial, Single-use In 1 Tray
4
N N Y 32%N33%NNAN
Revlimid 2.5mg 100 Capsule In 1 Bottle
5
30 30 Y N Y 25%N25%NNAN
Revlimid 5mg 100 Capsule In 1 Bottle
5
30 30 Y N Y 25%N25%NNAN
Revlimid 10mg 100 Capsule In 1 Bottle
5
30 30 Y N Y 25%N25%NNAN
Revlimid 15mg 21 Capsule In 1 Bottle
5
30 30 Y N Y 25%N25%NNAN
Revlimid 20mg 100 Capsule In 1 Bottle
5
30 30 Y N Y 25%N25%NNAN
Revlimid 25mg 100 Capsule In 1 Bottle
5
30 30 Y N Y 25%N25%NNAN
Reyataz 300mg 30 Capsule, Gelatin Coated In 1 Bottle, Plastic
5
60 30 N N Y 25%N25%NNAN
Reyataz 150mg 60 Capsule, Gelatin Coated In 1 Bottle, Plastic
5
60 30 N N Y 25%N25%NNAN
Reyataz 200mg 60 Capsule, Gelatin Coated In 1 Bottle, Plastic
5
90 30 N N Y 25%N25%NNAN
Ribasphere 200mg 168 Tablet, Film Coated In 1 Bottle
3
N N Y $27N$47NNAN
Ribasphere 400mg 56 Tablet, Film Coated In 1 Bottle
3
N N Y $27N$47NNAN
Ribasphere 600mg 56 Tablet, Film Coated In 1 Bottle
3
N N Y $27N$47NNAN
Ribavirin 200mg 168 Tablet, Film Coated In 1 Bottle
3
N N Y $27N$47NNAN
Rifabutin 150mg 100 Capsule In 1 Bottle
4
N N Y 32%N33%NNAN
Rifampin 300mg 60 Capsule In 1 Bottle
2
N N N $3N$18NNAN
Rifampin 150mg 30 Capsule In 1 Bottle
2
N N N $3N$18NNAN
Rifampin 10 Ml In 1 Vial, Glass
4
N N Y 32%N33%NNAN
Rifater 50; 300; 120mg/1; mg/1; mg 60 Tablet, Sugar Coated In 1 Bottle
4
N N Y 32%N33%NNAN
Riluzole 50mg 60 Tablet, Film Coated In 1 Bottle
3
N N Y $27N$47NNAN
Rimantadine Hydrochloride 100mg 100 Tablet, Film Coated In 1 Bottle
2
N N N $3N$18NNAN
Ringers .33; .3; 8.6g/1000mL; g/1000mL; g/1000mL 1000 Ml In 1 Bag
4
N N Y 32%N33%NNAN
Ringers 33; 30; 860mg/100mL; mg/100mL; mg/100mL 12 Bottle, Plastic In 1 Case > 1000 Ml In 1 Bottle, Plastic
3
N N Y $27N$47NNAN
Risperdal Consta 1 Kit In 1 Box * 2 Ml In 1 Vial * 2 Ml In 1 Syringe
4
N N Y 32%N33%NNAN
Risperdal Consta 1 Kit In 1 Box * 2 Ml In 1 Vial * 2 Ml In 1 Syringe
5
N N Y 25%N25%NNAN
Risperdal Consta 1 Kit In 1 Box * 2 Ml In 1 Vial * 2 Ml In 1 Syringe
5
N N Y 25%N25%NNAN
Risperdal Consta 1 Kit In 1 Box * 2 Ml In 1 Vial * 2 Ml In 1 Syringe
4
N N Y 32%N33%NNAN
Risperidone 2mg 60 Tablet, Film Coated In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Risperidone 3mg 60 Tablet, Film Coated In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Risperidone 28 Tablet, Orally Disintegrating In 1 Bottle, Plastic
4
N N Y 32%N33%NNAN
Risperidone 28 Tablet, Orally Disintegrating In 1 Bottle, Plastic
4
N N Y 32%N33%NNAN
Risperidone .5mg 500 Tablet In 1 Bottle
2
N N N $3N$18NNAN
Risperidone .25mg 5 Blister Pack In 1 Carton
4
N N Y 32%N33%NNAN
Risperidone 1mg 7 Blister Pack In 1 Carton
4
N N Y 32%N33%NNAN
Risperidone 3mg 7 Blister Pack In 1 Carton
4
N N Y 32%N33%NNAN
Risperidone 4mg 7 Blister Pack In 1 Carton
4
N N Y 32%N33%NNAN
Risperidone 1mg/mL 30 Ml In 1 Bottle
4
N N Y 32%N33%NNAN
Risperidone .25mg 60 Tablet, Film Coated In 1 Bottle
2
N N N $3N$18NNAN
Rituxan 10mg/mL 1 Vial, Single-use In 1 Carton > 50 Ml In 1 Vial, Single-use
5
Y N Y 25%N25%NNAN
Rivastigmine Tartrate 1.5mg 60 Capsule In 1 Bottle
2
60 30 N N N $3N$18NNAN
Rivastigmine Tartrate 3mg 60 Capsule In 1 Bottle
2
60 30 N N N $3N$18NNAN
Rivastigmine Tartrate 4.5mg 60 Capsule In 1 Bottle
2
60 30 N N N $3N$18NNAN
Rivastigmine Tartrate 6mg 60 Capsule In 1 Bottle
2
60 30 N N N $3N$18NNAN
Rizatriptan Benzoate 5mg 9 Tablet, Orally Disintegrating In 1 Bottle, Plastic
2
12 30 N N N $3N$18NNAN
Rizatriptan Benzoate 10mg 9 Tablet, Orally Disintegrating In 1 Bottle, Plastic
2
12 30 N N N $3N$18NNAN
Rizatriptan Benzoate 10mg 18 Blister Pack In 1 Carton
2
12 30 N N N $3N$18NNAN
Rizatriptan Benzoate 5mg 4 Blister Pack In 1 Carton
2
12 30 N N N $3N$18NNAN
Ropinirole Hydrochloride 1mg 100 Tablet In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Ropinirole Hydrochloride 2mg 100 Tablet In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Ropinirole Hydrochloride 3mg 100 Tablet In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Ropinirole Hydrochloride 4mg 100 Tablet In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Ropinirole Hydrochloride 5mg 100 Tablet In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Ropinirole Hydrochloride .25mg 100 Tablet In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Ropinirole Hydrochloride .5mg 100 Tablet In 1 Bottle, Plastic
2
N N N $3N$18NNAN
Rotarix 1 Kit In 1 Carton
3
N N Y $27N$47NNAN
Rotateq 2200000; 2800000; 2200000; 2000000; 2300000[iU]/2mL; [iU]/2mL; [iU]/2mL; [iU]/2mL; [iU]/2mL 10 Pouch In 1 Carton > 2 Ml In 1 Tube
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.