AARP MedicareRx Walgreens (PDP) Formulary



Below is the 2023 Formulary, or prescription drug list, from AARP MedicareRx Walgreens (PDP) by Unitedhealthcare Ins Co & Uhc Ins Co Of Ny. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a In Indiana, Kentucky. 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 MedicareRx Walgreens (PDP)(S5921-396) plan has a $350 drug deductible. A 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 $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. Unitedhealthcare Ins Co & Uhc Ins Co Of Ny 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 MedicareRx Walgreens (PDP)
Plan ID: S5921-396
Formulary
Provider: Unitedhealthcare Ins Co & Uhc Ins Co Of Ny
Plan Year:2023
Premium:$28.20
Deductible:$350
Initial Coverage Limit:$4660
Coverage Area:Indiana, Kentucky
Similar Plan:S5921-397


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
⇅ Click the Header to Sort
Drug
Name⇅
Tier
Level
Deductible
Apply
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/Days
Prior Auth
Y/N
Step
Therapy
Abacavir
4Y45%50%NA960/30NN
Abacavir And Lamivudine
4Y45%50%NA30/30NN
Abelcet
4Y45%50%NAYN
Abilify Maintena
527%27%27%NN
Abiraterone
4Y45%50%NA120/30YN
Abiraterone Acetate
4Y45%50%NA60/30YN
Acarbose
3Y$40$45NA360/30NN
Accutane
4Y45%50%NAYN
Acetaminophen And Codeine Phosphate
2Y$10$20NA4500/30NN
Acetaminophen, Caffeine, Dihydrocodeine Bitartrate
4Y45%50%NA300/30NN
Acetazolamide
3Y$40$45NANN
Acetic Acid
2Y$10$20NANN
Acetylcysteine
3Y$40$45NAYN
Acitretin
4Y45%50%NANN
Actemra
527%27%27%3/28YN
Actemra Actpen
527%27%27%3/28YN
Acthib
3Y$40$45NA1/1NN
Actimmune
527%27%27%NN
Acyclovir
4Y45%50%NANN
Acyclovir Sodium
4Y45%50%NAYN
Adapalene
3Y$40$45NANN
Adempas
527%27%27%YN
Advair
3Y$40$45NA60/30NN
Advair Hfa
3Y$40$45NA12/30NN
Aimovig
4Y45%50%NA1/30YN
Alacort
3Y$40$45NANN
Albendazole
4Y45%50%NA480/30NN
Albuterol Sulfate
2Y$10$20NANN
Alclometasone Dipropionate
3Y$40$45NANN
Alecensa
527%27%27%240/30YN
Alendronate Sodium
2Y$10$20NA4/28NN
Aliskiren
4Y45%50%NA30/30NN
Alosetron Hydrochloride
527%27%27%YN
Alprazolam
2Y$10$20NA150/30NN
Altavera
4Y45%50%NANN
Alunbrig
527%27%27%60/365YN
Alyacen 1/35
4Y45%50%NANN
Alyq
4Y45%50%NA60/30YN
Amantadine Hydrochloride
3Y$40$45NANN
Ambisome
4Y45%50%NAYN
Amethia
4Y45%50%NANN
Amikacin Sulfate
4Y45%50%NANN
Amiloride Hydrocloride
2Y$10$20NANN
Amitriptyline Hydrochloride
3Y$40$45NANN
Amlodipine And Benazepril Hydrochloride
2Y$10$20NA30/30NN
Amlodipine And Olmesartan Medoxomil
2Y$10$20NA30/30NN
Amlodipine And Valsartan
3Y$40$45NA30/30NN
Amlodipine Besylate
1N$1$16NANN
Amlodipine Besylate And Benazepril Hydrochloride
2Y$10$20NA30/30NN
Ammonium Lactate
3Y$40$45NANN
Amnesteem
4Y45%50%NAYN
Amoxapine
3Y$40$45NANN
Amoxicillin
2Y$10$20NANN
Amoxicillin And Clavulanate Potassium
2Y$10$20NANN
Amphotericin B
4Y45%50%NAYN
Ampicillin
4Y45%50%NANN
Ampicillin And Sulbactam
4Y45%50%NANN
Ampicillin Sodium And Sulbactam Sodium
4Y45%50%NANN
Anagrelide
3Y$40$45NANN
Anastrozole
2Y$10$20NANN
Androderm
3Y$40$45NA30/30NN
Apraclonidine Ophthalmic
3Y$40$45NANN
Aprepitant
4Y45%50%NA6/28YN
Apri
4Y45%50%NANN
Aptivus
527%27%27%120/30NN
Aralast
527%27%27%YN
Aranesp
527%27%27%YN
Aripiprazole
4Y45%50%NA60/30NN
Aristada
527%27%27%NN
Aristada Initio
527%27%27%NN
Armodafinil
4Y45%50%NA30/30YN
Armonair Digihaler
4Y45%50%NA1/30NN
Asenapine
4Y45%50%NA60/30NN
Ashlyna
4Y45%50%NANN
Atenolol And Chlorthalidone
3Y$40$45NANN
Atomoxetine
4Y45%50%NA30/30NN
Atovaquone
527%27%27%420/30NN
Atovaquone And Proguanil Hydrochloride Pediatric
3Y$40$45NANN
Atrovent
4Y45%50%NANN
Aubra Eq
4Y45%50%NANN
Auryxia
4Y45%50%NAYN
Aviane
4Y45%50%NANN
Ayvakit
527%27%27%30/30YN
Azathioprine
3Y$40$45NAYN
Azelaic Acid
4Y45%50%NA50/30NN
Azelastine Hcl Nasal
3Y$40$45NANN
Azelastine Hydrochloride
3Y$40$45NANN
Azithromycin
4Y45%50%NANN
Aztreonam
4Y45%50%NANN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for S5921-396

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1. Pre-Deductable: Before you reach the plans deductible of $350. 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 2022 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 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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