AARP Medicare Rx Preferred 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
$5.00 copay (30-day supply)
$15.00 copay (90-day supply)
Tier 2: Generic
$10.00 copay (30-day supply)
$30.00 copay (90-day supply)
Tier 3: Preferred Brand
$47.00 copay (30-day supply)
$141.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
40% coinsurance (30-day supply)
Tier 5: Specialty Tier
33% coinsurance (30-day supply)
Rx Drug Coverage - Standard Retail Cost
Tier 1: Preferred Generic
$13.00 copay (30-day supply)
$39.00 copay (90-day supply)
Tier 2: Generic
$18.00 copay (30-day supply)
$54.00 copay (90-day supply)
Tier 3: Preferred Brand
$47.00 copay (30-day supply)
$141.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
45% coinsurance (30-day supply)
Tier 5: Specialty Tier
33% coinsurance (30-day supply)
Rx Drug Coverage - Standard Mail Order Cost
Tier 1: Preferred Generic
$39.00 copay (90-day supply)
Tier 2: Generic
$54.00 copay (90-day supply)
Tier 3: Preferred Brand
$141.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
45% coinsurance (30-day supply)
Tier 5: Specialty Tier
33% coinsurance (30-day supply)
Rx Drug Coverage - Preferred Mail Order Cost
Tier 1: Preferred Generic
$0.00 copay (90-day supply)
Tier 2: Generic
$0.00 copay (90-day supply)
Tier 3: Preferred Brand
$126.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
40% coinsurance (30-day supply)
Tier 5: Specialty Tier
33% coinsurance (30-day supply)
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