Learn about this plan's prescription drug coverage and costs. Enter your prescriptions to see what they'd cost with this plan.
Costs | What you'll pay |
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Annual prescription deductible
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Annual prescription deductible
If your plan has an annual deductible, you (or others on your behalf) will pay your drug costs up to the amount of this deductible before moving into the Initial Coverage stage.
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$545 |
Annual prescription deductible
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Annual prescription deductible
If your plan has an annual deductible, you (or others on your behalf) will pay your drug costs up to the amount of this deductible before moving into the Initial Coverage stage.
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Tier 1: Preferred Generic |
Network pharmacy (30-day) $19 copay Standard mail order pharmacy (90-day) $57 copay |
Tier 1: Preferred Generic
Network pharmacy (30-day) $19 copay Standard mail order pharmacy (90-day) $57 copay |
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Tier 2: Generic |
Network pharmacy (30-day) $20 copay Standard mail order pharmacy (90-day) $60 copay |
Tier 2: Generic
Network pharmacy (30-day) $20 copay Standard mail order pharmacy (90-day) $60 copay |
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Tier 3: Preferred Brand |
Network pharmacy (30-day) $47 copay Standard mail order pharmacy (90-day) $141 copay |
Tier 3: Preferred Brand
Network pharmacy (30-day) $47 copay Standard mail order pharmacy (90-day) $141 copay |
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Tier 3: Covered Insulin |
Standard network pharmacy (30-day) $35 copay Standard mail order pharmacy (90-day) $105 copay |
Tier 3: Covered Insulin
Standard network pharmacy (30-day) $35 copay Standard mail order pharmacy (90-day) $105 copay |
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Tier 4: Non-preferred Generic or Brand |
Network pharmacy (30-day) 50% of the cost Standard mail order pharmacy (90-day) 50% of the cost |
Tier 4: Non-preferred Generic or Brand
Network pharmacy (30-day) 50% of the cost Standard mail order pharmacy (90-day) 50% of the cost |
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Tier 5: Specialty Tier |
Network pharmacy (30-day) 25% of the cost |
Tier 5: Specialty Tier
Network pharmacy (30-day) 25% of the cost |
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Coverage Gap stage | In this stage, you pay 25% of the negotiated price for covered drugs. You pay less if your plan has additional coverage in the gap. You pay this amount until your total out-of-pocket cost reaches $8,000. |
Coverage Gap stage In this stage, you pay 25% of the negotiated price for covered drugs. You pay less if your plan has additional coverage in the gap. You pay this amount until your total out-of-pocket cost reaches $8,000. | |
Catastrophic Coverage stage | After your total out-of-pocket drug costs reach $8,000, you won't pay anything for Medicare Part D covered drugs for the rest of the plan year. For excluded drugs covered under any enhanced benefit, you pay a cost share. |
Catastrophic Coverage stage After your total out-of-pocket drug costs reach $8,000, you won't pay anything for Medicare Part D covered drugs for the rest of the plan year. For excluded drugs covered under any enhanced benefit, you pay a cost share. |
Important documents that provide the details you need about this plan's coverage and benefits, prescription drugs, enrollment, providers and more.
General Plan Information |
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General Plan Information
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Prescription Drug Coverage |
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Prescription Drug Coverage
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Pharmacy Directory | |
Pharmacy Directory |
General Plan Information |
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General Plan Information
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Prescription Drug Coverage |
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Prescription Drug Coverage
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Pharmacy Directory | |
Pharmacy Directory |
Enrollment Disclaimer Information:
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare. UnitedHealthcare Insurance Company paid royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. You do not need to be an AARP member to enroll. AARP encourages you to consider your needs when selecting products and does not make specific product or pharmacy recommendations for individuals. UnitedHealthcare contracts directly with Walgreens for this plan; AARP and its affiliates are not parties to that contractual relationship.
Extra Help:
If you receive Extra Help from Medicare, your copays may be lower or you may have no copays.
The Medicare Prescription Payment Plan:
Starting Jan. 1, 2025, if you spend more than $2,000 for covered Part D prescription drugs each year, you may want to participate in the Medicare Prescription Payment Plan. This payment plan spreads your out-of-pocket prescription drug costs over the remainder of the calendar year. Learn more about the Medicare Prescription Payment Plan.
Other Languages:
This information is available for free in other languages. Please contact Customer Service for additional information.
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