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 | $0 |
Annual prescription deductible $0 |
Retail network pharmacy (30-day supply) | What you'll pay |
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Tier 1: Preferred Generic Drugs |
Preferred network pharmacy (30-day) $5 copay Standard Network pharmacy (30-day) $13 copay |
Tier 1: Preferred Generic Drugs
Preferred network pharmacy (30-day) $5 copay Standard Network pharmacy (30-day) $13 copay |
|
Tier 2: Generic Drugs |
Preferred network pharmacy (30-day) $10 copay Standard Network pharmacy (30-day) $18 copay |
Tier 2: Generic Drugs
Preferred network pharmacy (30-day) $10 copay Standard Network pharmacy (30-day) $18 copay |
|
Tier 3: Preferred Brand Drugs |
Preferred network pharmacy (30-day) $47 copay Standard Network pharmacy (30-day) $47 copay |
Tier 3: Preferred Brand Drugs
Preferred network pharmacy (30-day) $47 copay Standard Network pharmacy (30-day) $47 copay |
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Tier 3: Insulin |
Preferred network pharmacy (30-day) $35 copay Standard network pharmacy (30-day) $35 copay |
Tier 3: Insulin
Preferred network pharmacy (30-day) $35 copay Standard network pharmacy (30-day) $35 copay |
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Tier 4: Non-preferred Drugs |
Preferred network pharmacy (30-day) 40% of the cost Standard Network pharmacy (30-day) 45% of the cost |
Tier 4: Non-preferred Drugs
Preferred network pharmacy (30-day) 40% of the cost Standard Network pharmacy (30-day) 45% of the cost |
|
Tier 5: Specialty Drugs |
Preferred network pharmacy (30-day) 33% of the cost Standard Network pharmacy (30-day) 33% of the cost |
Tier 5: Specialty Drugs
Preferred network pharmacy (30-day) 33% of the cost Standard Network pharmacy (30-day) 33% of the cost |
Mail order pharmacy | What you'll pay |
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Tier 1: Preferred Generic Drugs | $0 copay |
Tier 1: Preferred Generic Drugs $0 copay | |
Tier 2: Generic Drugs | $0 copay |
Tier 2: Generic Drugs $0 copay | |
Tier 3: Preferred Brand Drugs | $126 copay |
Tier 3: Preferred Brand Drugs $126 copay | |
Tier 3: Insulin | $105 copay |
Tier 3: Insulin $105 copay |
Cost shares if you receive Extra Help | What you'll pay |
---|---|
Brand Drugs | Up to $12.15 copay |
Brand Drugs Up to $12.15 copay | |
Generic Drugs | Up to $4.90 copay |
Generic Drugs Up to $4.90 copay |
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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本資訊可以其他語言免費提供。如需更多資訊,請聯絡客戶服務部。
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