2020 Medicare Prescription Drug Plan Cost-Sharing Details

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2020 Medicare Part D Prescription Drug
Formulary (Drug List) Cost-Sharing Details
AARP MedicareRx Walgreens (PDP) (S5921-412-0)
Benefits & Contact Info        
This plan is available in CMS PDP Region 31
which includes: ID UT

Monthly Premium: $33.50
Rx Deductible: $435
Initial Coverage Limit: $4,020 Qualifies for LIS: No


Click on a letter below to view the
AARP MedicareRx Walgreens (PDP) Formulary
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This Plan Uses Lower Cost-Sharing for Preferred Pharmacies
  30-Day Supply
Cost-Sharing
90-Day Supply
Cost-Sharing
Preferred Pharmacy Standard Pharmacy Mail- Order* Preferred Pharmacy Standard Pharmacy Mail- Order*
Initial Deductible Phase Cost Sharing
Tier 1: Preferred Generic: $0.00(E) $15.00(E) n/a(E) $0.00(E) $45.00(E) $0.00(E)
Tier 2: Generic: $5.00(E) $20.00(E) n/a(E) $15.00(E) $60.00(E) $15.00(E)
Tier 3: Preferred Brand: 100% 100% 100% 100% 100% 100%
Tier 4: Non-Preferred Drug: 100% 100% 100% 100% 100% 100%
Tier 5: Specialty Tier: 100% 100% 100% 100% 100% 100%
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $0.00 $15.00 n/a $0.00 $45.00 $0.00
Tier 2: Generic: $5.00 $20.00 n/a $15.00 $60.00 $15.00
Tier 3: Preferred Brand: $40.00 $47.00 n/a $120.00 $141.00 $120.00
Tier 4: Non-Preferred Drug: 32% 33% n/a 32% 33% 32%
Tier 5: Specialty Tier: 25% 25% n/a 25% 25% 25%
Coverage Gap (Donut Hole) Phase Cost Sharing
Plan offers no Gap Coverage 75% Generic and 75% Brand Donut Hole Discount applies
All Formulary Generic Drugs: 25% 25% 25% 25% 25% 25%
All Formulary Brand-Name Drugs: 25% 25% 25% 25% 25% 25%
Catastrophic Coverage Phase Cost Sharing
Generic & Preferred Multi-Source Drugs: The greater of 5% or $3.60 The greater of 5% or $3.60
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $8.95 The greater of 5% or $8.95
Notes:
*The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing.
(E) Drugs on this tier are excluded from the Initial Deductible and do not count toward meeting the deductible.
Go to the AARP MedicareRx Walgreens (PDP) 2020 Formulary Browser by choosing a letter below:
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