AARP Medicare Advantage Walgreens Plan 1 (PPO) Formulary



Below is the 2023 Formulary, or prescription drug list, from AARP Medicare Advantage Walgreens Plan 1 (PPO) by Care Improvement Plus South Central Insurance Co. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a Arizona Medicare Part-C plan that covers your prescriptions. It also helps you compare costs among Medicare Part D and Medicare Advantage plans available to you. You’ll want to make sure the medicines you are currently taking are covered under any plans you are considering enrolling in.

This AARP Medicare Advantage Walgreens Plan 1 (PPO)(H2228-074) plan has a $0 drug deductible. The Initial Coverage Limit (ICL) for this plan is $4660. 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 $4660 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 25% 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" by clicking the "Coverage Gap" link above the chart.

In 2023 if you have spent $7400 in expenditures you enter the Catastrophic Phase. During the Catastrophic Period you will begin to receive significant coverage. Care Improvement Plus South Central Insurance Co 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 above the chart.



Plan Overview

Plan Name:AARP Medicare Advantage Walgreens Plan 1
Plan ID: H2228-074
Provider: Care Improvement Plus South Central Insurance Co
Plan Year:2023
Premium:$0.00
Deductible:$0
Initial Coverage Limit:$4660
Coverage Area:Arizona
Similar Plan:H2228-075


Change Table Options:

Drugs Starting Letter:
Coverage Phase:

*Tip Click the Drug name to Compare Coverage and Retail Cost for Every Plan In Your Area
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Drug
Name⇅
Tier
Level
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/Days
Prior Auth
Y/N
Step
Therapy
Abacavir
4$100$100NA960/30NN
Abacavir And Lamivudine
4$100$100NA30/30NN
Abelcet
4$100$100NAYN
Abilify Maintena
533%33%33%NN
Abiraterone
4$100$100NA120/30YN
Abiraterone Acetate
533%33%33%60/30YN
Acarbose
1$0$10NA360/30NN
Accutane
4$100$100NAYN
Acebutolol Hydrochloride
2$0$20NANN
Acetaminophen And Codeine Phosphate
2$0$20NA4500/30NN
Acetaminophen, Caffeine, Dihydrocodeine Bitartrate
4$100$100NA300/30NN
Acetazolamide
3$47$47NANN
Acetic Acid
2$0$20NANN
Acetylcysteine
2$0$20NAYN
Acitretin
4$100$100NANN
Actemra
533%33%33%3/28YN
Actemra Actpen
533%33%33%3/28YN
Acthib
3$47$47NA1/1NN
Actimmune
533%33%33%NN
Acyclovir
3$47$47NANN
Acyclovir Sodium
4$100$100NAYN
Adapalene
3$47$47NANN
Adefovir Dipivoxil
4$100$100NANN
Adempas
533%33%33%YN
Advair
3$47$47NA60/30NN
Advair Hfa
3$47$47NA12/30NN
Aimovig
4$100$100NA1/30YN
Alacort
2$0$20NANN
Albendazole
4$100$100NA480/30NN
Albuterol Sulfate
2$0$20NANN
Alclometasone Dipropionate
3$47$47NANN
Alecensa
533%33%33%240/30YN
Alendronate Sodium
1$0$10NA4/28NN
Aliskiren
1$0$10NA30/30NN
Alocril
4$100$100NANN
Alomide
4$100$100NANN
Alosetron Hydrochloride
533%33%33%YN
Alprazolam
1$0$10NA150/30NN
Altavera
4$100$100NANN
Alunbrig
533%33%33%60/365YN
Alyacen 1/35
4$100$100NANN
Alyq
4$100$100NA60/30YN
Amantadine Hydrochloride
3$47$47NANN
Ambisome
533%33%33%YN
Amethia
4$100$100NANN
Amikacin Sulfate
4$100$100NANN
Amiloride Hydrochloride And Hydrochlorothiazide
2$0$20NANN
Amiloride Hydrocloride
2$0$20NANN
Amitriptyline Hydrochloride
4$100$100NANN
Amlodipine And Benazepril Hydrochloride
1$0$10NA30/30NN
Amlodipine And Olmesartan Medoxomil
1$0$10NA30/30NN
Amlodipine And Valsartan
1$0$10NA30/30NN
Amlodipine Besylate
1$0$10NANN
Amlodipine Besylate And Benazepril Hydrochloride
1$0$10NA30/30NN
Ammonium Lactate
3$47$47NANN
Amnesteem
4$100$100NAYN
Amoxapine
3$47$47NANN
Amoxicillin
1$0$10NANN
Amoxicillin And Clavulanate Potassium
2$0$20NANN
Amphotericin B
4$100$100NAYN
Ampicillin
4$100$100NANN
Ampicillin And Sulbactam
4$100$100NANN
Ampicillin Sodium And Sulbactam Sodium
4$100$100NANN
Anagrelide
3$47$47NANN
Anastrozole
1$0$10NANN
Androderm
3$47$47NA30/30NN
Anzemet
4$100$100NAYN
Apraclonidine Ophthalmic
3$47$47NANN
Aprepitant
4$100$100NA6/28YN
Apri
4$100$100NANN
Aptivus
533%33%33%120/30NN
Aralast
533%33%33%YN
Aranelle
4$100$100NANN
Aranesp
533%33%33%YN
Aripiprazole
533%33%33%60/30NN
Aristada
533%33%33%NN
Aristada Initio
533%33%33%NN
Armodafinil
4$100$100NA30/30YN
Arnuity Ellipta
3$47$47NA30/30NN
Asenapine
4$100$100NA60/30NN
Ashlyna
4$100$100NANN
Atenolol And Chlorthalidone
1$0$10NANN
Atomoxetine
4$100$100NA30/30NN
Atovaquone
533%33%33%420/30NN
Atovaquone And Proguanil Hydrochloride Pediatric
3$47$47NANN
Atrovent
4$100$100NANN
Aubra Eq
4$100$100NANN
Auryxia
533%33%33%YN
Austedo
533%33%33%120/30YN
Aviane
4$100$100NANN
Avonex
533%33%33%1/28NN
Ayvakit
533%33%33%30/30YN
Azathioprine
2$0$20NAYN
Azelaic Acid
4$100$100NA50/30NN
Azelastine Hcl Nasal
3$47$47NANN
Azelastine Hydrochloride
3$47$47NANN
Azelastine Hydrochloride And Fluticasone Propionat
4$100$100NANN
Azithromycin
4$100$100NANN
Aztreonam
4$100$100NANN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H2228-074

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1. Pre-Deductable: Before you reach the plans deductible of $0. 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 $4660
3. Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $7400 in 2023.
4. Catastrophic: Anything over $7400 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 2023 is $505. 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 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 Preferred: Your Cost for the Drug at the Providers In-Network Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Non-Preferred: Your Cost for the Prescription Drug at a Non-Preferred 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 plan's 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.

Last updated on

Source:CMS Formulary Data Q4 2022
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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