AARP Medicare Rx Walgreens from UHC (PDP)
Health Insurance Company: UnitedHealthcare®
Medicare Prescription Drug Part D Plan Details
- Rx
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
$40.00 copay (30-day supply)
$120.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
50% coinsurance (30-day supply)
50% coinsurance (90-day supply)
Tier 5: Specialty Tier
27% coinsurance (30-day supply)
Rx Drug Coverage - Standard Retail Cost
Tier 1: Preferred Generic
$17.00 copay (30-day supply)
$51.00 copay (90-day supply)
Tier 2: Generic
$20.00 copay (30-day supply)
$60.00 copay (90-day supply)
Tier 3: Preferred Brand
$45.00 copay (30-day supply)
$135.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
50% coinsurance (30-day supply)
50% coinsurance (90-day supply)
Tier 5: Specialty Tier
27% coinsurance (30-day supply)
Rx Drug Coverage - Standard Mail Order Cost
Tier 1: Preferred Generic
$51.00 copay (90-day supply)
Tier 2: Generic
$60.00 copay (90-day supply)
Tier 3: Preferred Brand
$135.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
50% coinsurance (90-day supply)
Tier 5: Specialty Tier
27% 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
$120.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
50% coinsurance (90-day supply)
Tier 5: Specialty Tier
27% coinsurance (30-day supply)
Plan Links
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