MedicarePartD.guide

A non-government resource built from CMS public data

AARP Medicare Rx Preferred from UHC (PDP)

Contract S5921, plan 406, segment 0 · offered by UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY · CMS PDP Region 25 (South Dakota).

Plan features

Monthly premium$140.20
Annual deductible$130.00Tier 1 and 2 exempt
Drug benefit type—
$0 premium with full LIS—
Premium with Extra Help (LIS)—
Formulary drugs3,593
Formulary exception tier—
Mail order offered—
Plan reach—
Members in South Dakota—
Members nationally—
Member services—
BIN / PCN—

CMS star ratings

Summary rating
2 out of 5 stars for Summary rating
Customer service
—
Member experience
—
Drug pricing & patient safety
—

Formulary tiers — preferred pharmacy, initial coverage phase

TierCost-sharingDrugs on tier
Tier 1$5.00—
Tier 2$10.00—
Tier 318%—
Tier 434%—
Tier 531%—

Cost-sharing by coverage phase

Tier30-day supply90-day supply
PreferredStandardMail OrderPreferredStandardMail Order
Initial deductible phase
Tier 1: Preferred Generic$5.00$13.00n/a$15.00$39.00$0.00
Tier 2: Generic$10.00$18.00n/a$30.00$54.00$0.00
Initial coverage phase
Tier 1: Preferred Generic$5.00$13.00n/a$15.00$39.00$0.00
Tier 2: Generic$10.00$18.00n/a$30.00$54.00$0.00
Tier 3: Preferred Brand18%18%n/a18%18%18%
Tier 4: Non-Preferred Drug34%39%34%n/an/an/a
Tier 5: Specialty Tier31%31%31%n/an/an/a
Catastrophic coverage phase
Tier 1: Preferred Generic$0.00$0.00$0.00$0.00$0.00$0.00
Tier 2: Generic$0.00$0.00$0.00$0.00$0.00$0.00
Tier 3: Preferred Brand$0.00$0.00$0.00$0.00$0.00$0.00
Tier 4: Non-Preferred Drug$0.00$0.00$0.00$0.00$0.00$0.00
Tier 5: Specialty Tier$0.00$0.00$0.00$0.00$0.00$0.00