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2021 Pennsylvania Medicare Part D Prescription Drug Plan Highlights

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2021 Pennsylvania Stand-Alone Prescription Drug Plan Highlights
CMS PDP Region 6
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 2022  2021  2020  2019  2018  2017  2016  2015  2014  2013  2012  2011  2010  2009  2008  2007  2006

The information below is for research purposes. Enrollment in the 2021 plans is no longer available.

Lowest Premium Medicare Part D Plan (PDP) in Pennsylvania
Click here to see all PA PDPs
Plan Name
Plan ID		 Monthly
Prem.		 Dedu-
ctible		 (Donut Hole)
Additional
Gap
Coverage		 Preferred Pharmacy
Copay/Coinsurance
30-Day Supply		Total Formulary Drugs
SilverScript SmartRx (PDP)
(S5601-181)
Benefit Details

        		 $7.30 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $0.00
Generic: $19.00
Preferred Brand: $46.00
Non-Preferred Drug: 49%
Specialty Tier: 25%
3,664

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:



Lowest Premium $0 Deductible PA Prescription Drug Plan (PDP)
Click here to see all Pennsylvania $0 deductible PDP plans by premium lowest to highest
Plan Name
Plan ID		 Monthly
Prem.		 Dedu-
ctible		 Additional
Gap
Coverage		 Preferred Pharmacy
Copay/Coinsurance		Total Drugs
Indy Health EliteRx (PDP)
(S3535-005)
Benefit Details

        		 $47.10 $0 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $3.00
Generic: $5.00
Preferred Brand: $47.00
Non-Preferred Drug: 50%
Specialty Tier: 33%
3,578

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:



Five (5) Most Popular Medicare Part D Plans (PDP) in Pennsylvania
Click here to see all Pennsylvania PDP plans by popularity
Plan Name
Plan ID		 Monthly
Prem.		 Dedu-
ctible		 Additional
Gap
Coverage		 Preferred Pharmacy
Copay/Coinsurance		 State Members
SilverScript Choice (PDP)
(S5601-012)
Benefit Details

        		 $32.90 $345 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $0.00
Generic: $5.00
Preferred Brand: $35.00
Non-Preferred Drug: 40%
Specialty Tier: 26%
164,257

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
AARP MedicareRx Preferred (PDP)
(S5820-005)
Benefit Details

        		 $87.20 $0 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $5.00
Generic: $10.00
Preferred Brand: $45.00
Non-Preferred Drug: 40%
Specialty Tier: 33%
89,551

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
SilverScript SmartRx (PDP)
(S5601-181)
Benefit Details

        		 $7.30 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $0.00
Generic: $19.00
Preferred Brand: $46.00
Non-Preferred Drug: 49%
Specialty Tier: 25%
57,146

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
AARP MedicareRx Saver Plus (PDP)
(S5921-351)
Benefit Details

        		 $34.30 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $1.00
Generic: $5.00
Preferred Brand: $33.00
Non-Preferred Drug: 40%
Specialty Tier: 25%
51,719

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Classic (PDP)
(S4802-080)
Benefit Details

        		 $33.80 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $0.00
Generic: $3.00
Preferred Brand: $33.00
Non-Preferred Drug: 34%
Specialty Tier: 25%
51,549

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:



Pennsylvania Medicare Prescription Drug Plans (PDP) Under $30
Click here for all PA Medicare Prescription Drug plans
Plan Name
Plan ID		 Monthly
Prem.		 Dedu-
ctible		 Additional
Gap
Coverage		 Preferred Pharmacy
Copay/Coinsurance		Total Drugs
SilverScript SmartRx (PDP)
(S5601-181)
Benefit Details

        		 $7.30 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $0.00
Generic: $19.00
Preferred Brand: $46.00
Non-Preferred Drug: 49%
Specialty Tier: 25%
3,664

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Clear Spring Health Premier Rx (PDP)
(S6946-032)
Benefit Details

        		 $13.60 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $1.00
Generic: $3.00
Preferred Brand: $40.00
Non-Preferred Drug: 42%
Specialty Tier: 25%
3,297

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Elixir RxPlus (PDP)
(S7694-126)
Benefit Details

        		 $15.60 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $1.00
Generic: $6.00
Preferred Brand: $43.00
Non-Preferred Drug: 45%
Specialty Tier: 25%
3,301

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Wellness Rx (PDP)
(S4802-175)
Benefit Details

        		 $15.70 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $0.00
Generic: $5.00
Preferred Brand: $40.00
Non-Preferred Drug: 46%
Specialty Tier: 25%

select insulin pay $35 copay		3,503

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Humana Walmart Value Rx Plan (PDP)
(S5884-185)
Benefit Details

        		 $17.20 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $1.00
Generic: $4.00
Preferred Brand: 19%
Non-Preferred Drug: 35%
Specialty Tier: 25%
3,222

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Value Script (PDP)
(S4802-141)
Benefit Details

        		 $17.80 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $0.00
Generic: $6.00
Preferred Brand: $43.00
Non-Preferred Drug: 47%
Specialty Tier: 25%

select insulin pay $35 copay		3,503

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Cigna Secure-Essential Rx (PDP)
(S5617-285)
Benefit Details

        		 $24.00 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $0.00
Generic: $2.00
Preferred Brand: 18%
Non-Preferred Drug: 50%
Specialty Tier: 25%
3,193

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Mutual of Omaha Rx Premier (PDP)
(S7126-075)
Benefit Details

        		 $24.80 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $0.00
Generic: $2.00
Preferred Brand: 23%
Non-Preferred Drug: 45%
Specialty Tier: 25%

select insulin pay $25 copay		2,993

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Express Scripts Medicare - Saver (PDP)
(S5660-222)
Benefit Details

        		 $25.90 $285 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $2.00
Generic: $7.00
Preferred Brand: $35.00
Non-Preferred Drug: 50%
Specialty Tier: 28%

select insulin pay $35 copay		3,030

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Medicare Rx Select (PDP)
(S5810-280)
Benefit Details

        		 $26.40 $415 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $0.00
Generic: $3.00
Preferred Brand: $47.00
Non-Preferred Drug: 42%
Specialty Tier: 25%
3,503

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Clear Spring Health Value Rx (PDP)
(S6946-003)
Benefit Details

        		 $29.20 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $1.00
Generic: $3.00
Preferred Brand: $42.00
Non-Preferred Drug: 34%
Specialty Tier: 25%
3,276

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Cigna Secure Rx (PDP)
(S5617-215)
Benefit Details

        		 $30.00 $445 No additional gap coverage, only the Donut Hole DiscountPreferred Generic: $1.00
Generic: $2.00
Preferred Brand: $30.00
Non-Preferred Drug: 50%
Specialty Tier: 25%
Select Care Drugs: $0.00
3,241

Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:


A few notes to help with the understanding of the 2021 Medicare Part D Plan chart above.
  • Plan Name: This is the official plan name from the Centers for Medicare and Medicaid Services (CMS). The same plan name generally has a different plan id in each state.

  • Plan ID: This is the unique id for this particular plan.

  • Monthly Premium: This is the amount you must pay each month to use the plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: The standard CMS plan initial deductible is $445. Many Medicare plans do not have a deductible; however their plan premium may be higher.

  • Gap Coverage: In the CMS Standard Plan, the beneficiary, or others on their behalf (e.g. the brand-name drug manufacturer discount), pay(s) up to $5,184 in drug costs, depending on your mix of generics and brand-name drugs. The Healthcare Reform provides that for plan year 2021, all formulary drugs will have at least a 75% discount in the coverage gap (Donut Hole). The Gap Coverage Types discussed in this section are supplemental coverage your plan pays in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following:
    • No Gap Coverage: You receive the 75% Donut Hole Discount and pay up to $5,184 depending on your mix of generics and brand-name drugs, before exiting into Catastrophic Coverage. Read more...
    • Yes: This plan offers some supplemental gap coverage in addition to the 75% Donut Hole Discount. See plan details for a description of the gap coverage. The description may read similar to: Under this plan you may pay even less for the brand and generic drugs on the formulary. Your cost varies by tier. You will need to use your formulary to locate your drug's tier. See the chart that follows to find out how much it will cost you.

  • Copay / Coinsurance - Cost Sharing - This is what you will pay for formulary drugs in the Initial Coverage Phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. Plans can form their own tiers, so you should contact the plan or reference their summary of benefits to find out what copays and limitations are associated with each tier. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap.

    * When the text "insulin coverage $35 or less" appears, this Part D plan may offer particular forms of insulin as part of the Senior Savings Model.  The Senior Savings Model stipulates that some insulin will cost no more than $35 in the deductible, initial coverage, and coverage gap phases of your Part D plan. Please contact the drug plan for more details.

  • Total Formulary Drugs (default) - This is the total number of medications on the plans formulary or drug list. This total drug count does not include "Bonus Drugs". These are non-Medicare Part D drugs which are covered by the plan, however they do not count toward your plan deductible, retail drug cost, or TrOOP.

(Chart Source: Centers for Medicare and Medicaid file 2021 PDP Landscape Source file)

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information. Through the application process we will provide you with the most up-to-the-minute information/pricing.



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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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