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This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2021 North Carolina Medicare Part D Prescription Drug Plan Highlights

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See all North Carolina national and regional Medicare Part D (PDP) plan details (copays/coinsurance, plan ratings, formulary, enrollment figures, etc.)
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2021 North Carolina Stand-Alone Prescription Drug Plan Highlights
CMS PDP Region 8
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The information below is for research purposes. Enrollment in the 2021 plans is no longer available.

Lowest Premium Medicare Part D Plan (PDP) in North Carolina
Click here to see all NC 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) (S5601-183) Benefit Details			$7.20	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $19.00 Preferred Brand: $46.00 Non-Preferred Drug: 48% Specialty Tier: 25%		3,664 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:

Lowest Premium $0 Deductible NC Prescription Drug Plan (PDP)
Click here to see all North Carolina $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
SilverScript Plus (PDP) (S5601-017) Benefit Details			$61.60	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%		3,168 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:

Five (5) Most Popular Medicare Part D Plans (PDP) in North Carolina
Click here to see all North Carolina PDP plans by popularity
Plan Name Plan ID	Monthly Prem.	Dedu- ctible	Additional Gap Coverage	Preferred Pharmacy Copay/Coinsurance	State Members
SilverScript Choice (PDP) (S5601-016) Benefit Details	$25.10	$330	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 27%	115,768 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
AARP MedicareRx Preferred (PDP) (S5820-007) Benefit Details	$86.00	$0	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: 40% Specialty Tier: 33%	57,001 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Humana Basic Rx Plan (PDP) (S5884-133) Benefit Details	$27.70	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 25%	50,673 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Humana Premier Rx Plan (PDP) (S5884-154) Benefit Details	$65.30	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Drug: 49% Specialty Tier: 25%	35,538 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Humana Walmart Value Rx Plan (PDP) (S5884-187) Benefit Details	$17.20	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: 17% Non-Preferred Drug: 35% Specialty Tier: 25%	35,464 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:

North Carolina Medicare Prescription Drug Plans (PDP) Under $30
Click here for all NC Medicare Prescription Drug plans
Plan Name Plan ID	Monthly Prem.	Dedu- ctible	Additional Gap Coverage	Preferred Pharmacy Copay/Coinsurance	Total Drugs
SilverScript SmartRx (PDP) (S5601-183) Benefit Details	$7.20	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $19.00 Preferred Brand: $46.00 Non-Preferred Drug: 48% Specialty Tier: 25%	3,664 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Clear Spring Health Premier Rx (PDP) (S6946-034) Benefit Details	$13.90	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: $40.00 Non-Preferred Drug: 41% Specialty Tier: 25%	3,297 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Elixir RxPlus (PDP) (S7694-128) Benefit Details	$14.30	$445	No additional gap coverage, only the Donut Hole Discount	Preferred 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) (S4802-177) Benefit Details	$15.30	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $6.00 Preferred Brand: $43.00 Non-Preferred Drug: 48% Specialty Tier: 25% select insulin pay $35 copay	3,503 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Value Script (PDP) (S4802-143) Benefit Details	$17.20	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $43.00 Non-Preferred Drug: 49% 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) (S5884-187) Benefit Details	$17.20	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: 17% Non-Preferred Drug: 35% Specialty Tier: 25%	3,222 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Cigna Secure-Essential Rx (PDP) (S5617-287) Benefit Details	$23.00	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: 18% Non-Preferred Drug: 42% Specialty Tier: 25%	3,193 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Clear Spring Health Value Rx (PDP) (S6946-005) Benefit Details	$24.70	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: $42.00 Non-Preferred Drug: 33% Specialty Tier: 25%	3,276 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Cigna Secure Rx (PDP) (S5617-217) Benefit Details	$24.90	$445	No additional gap coverage, only the Donut Hole Discount	Preferred 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:
WellCare Classic (PDP) (S4802-081) Benefit Details	$24.90	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Drug: 35% Specialty Tier: 25%	3,133 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Mutual of Omaha Rx Premier (PDP) (S7126-077) Benefit Details	$25.00	$445	No additional gap coverage, only the Donut Hole Discount	Preferred 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:
SilverScript Choice (PDP) (S5601-016) Benefit Details	$25.10	$330	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 27%	3,109 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Elixir RxSecure (PDP) (S7694-008) Benefit Details	$26.00	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: 15% Non-Preferred Drug: 32% Specialty Tier: 25%	3,249 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Medicare Rx Select (PDP) (S5810-282) Benefit Details	$26.40	$365	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $47.00 Non-Preferred Drug: 42% Specialty Tier: 26%	3,503 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Medicare Rx Saver (PDP) (S5810-042) Benefit Details	$26.50	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: 35% Specialty Tier: 25%	3,133 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
AARP MedicareRx Saver Plus (PDP) (S5921-353) Benefit Details	$26.50	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Drug: 40% Specialty Tier: 25%	3,165 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Express Scripts Medicare - Saver (PDP) (S5660-224) Benefit Details	$26.50	$285	No additional gap coverage, only the Donut Hole Discount	Preferred 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:
Exemplar Health Basic (PDP) (S9325-002) Benefit Details	$27.10	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Generic: $6.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25%	3,221 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Humana Basic Rx Plan (PDP) (S5884-133) Benefit Details	$27.70	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 25%	3,125 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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