AARP Medicare Rx Saver from UHC (PDP)
Health Insurance Company: UnitedHealthcareⓇ
Medicare Prescription Drug Part D Plan Details
- Rx
- Low Income
Subsidy
General Plan Details
Rx Drug Coverage - Preferred Retail Cost
Tier 1: Preferred Generic
$2.00 copay (30-day supply)
$6.00 copay (90-day supply)
Tier 2: Generic
$8.00 copay (30-day supply)
$24.00 copay (90-day supply)
Tier 3: Preferred Brand
17% coinsurance (30-day supply)
17% coinsurance (90-day supply)
Tier 4: Non-Preferred Drug
37% coinsurance (30-day supply)
Tier 5: Specialty Tier
25% coinsurance (30-day supply)
Rx Drug Coverage - Standard Retail Cost
Tier 1: Preferred Generic
$8.00 copay (30-day supply)
$24.00 copay (90-day supply)
Tier 2: Generic
$10.00 copay (30-day supply)
$30.00 copay (90-day supply)
Tier 3: Preferred Brand
17% coinsurance (30-day supply)
17% coinsurance (90-day supply)
Tier 4: Non-Preferred Drug
40% coinsurance (30-day supply)
Tier 5: Specialty Tier
25% coinsurance (30-day supply)
Rx Drug Coverage - Standard Mail Order Cost
Tier 1: Preferred Generic
$24.00 copay (90-day supply)
Tier 2: Generic
$30.00 copay (90-day supply)
Tier 3: Preferred Brand
17% coinsurance (90-day supply)
Tier 4: Non-Preferred Drug
40% coinsurance (30-day supply)
Tier 5: Specialty Tier
25% coinsurance (30-day supply)
Rx Drug Coverage - Preferred Mail Order Cost
Tier 1: Preferred Generic
$6.00 copay (90-day supply)
Tier 2: Generic
$24.00 copay (90-day supply)
Tier 3: Preferred Brand
17% coinsurance (90-day supply)
Tier 4: Non-Preferred Drug
37% coinsurance (30-day supply)
Tier 5: Specialty Tier
25% coinsurance (30-day supply)
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