2021 Medicare Prescription Drug Plan Cost-Sharing Details

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2021 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
AARP MedicareRx Preferred (PDP) (S5820-015-0)
Benefits & Contact Info        
insulin coverage $35 or less
This plan is available in CMS PDP Region 16
Monthly Premium: $92.80
Rx Deductible: $0
Initial Coverage Limit: $4,130 Qualifies for LIS: No


Click on a letter below to view the
AARP MedicareRx Preferred (PDP) Formulary
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This Plan Uses Lower Cost-Sharing for Preferred Pharmacies
This PDP may offer some forms of insulin as part of the Senior Savings Model.  The Senior Savings Model stipulates that participating insulins will cost no more than $35 in the deductible, initial coverage, and coverage gap phases of your PDP.
The Medicare provided information below reflects the normal cost-sharing,
NOT the $35 copay.
Please contact the drug plan for more details.
  30-Day Supply
Cost-Sharing
90-Day Supply
Cost-Sharing
Preferred Pharmacy Standard Pharmacy Mail- Order* Preferred Pharmacy Standard Pharmacy Mail- Order*
This plan does not have an Initial Deductible:n/an/an/an/an/an/a
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $5.00 $15.00 n/a $15.00 $45.00 $0.00
Tier 2: Generic: $10.00 $20.00 n/a $30.00 $60.00 $0.00
Tier 3: Preferred Brand: $45.00 $47.00 n/a $135.00 $141.00 $120.00
Tier 4: Non-Preferred Drug: 40% 45% n/a 40% 45% 40%
Tier 5: Specialty Tier: 33% 33% 33% n/a n/a n/a
Coverage Gap (Donut Hole) Phase Cost Sharing
75% Generic and 75% Brand Donut Hole Discount applies to all drugs even those with coverage in the gap
Tier 2: Generic: $10.00(P) $20.00(P) n/a $30.00(P) $60.00(P) $0.00(P)
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 $3.70 The greater of 5% or $3.70
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $9.20 The greater of 5% or $9.20
Notes:
*The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing.
(A) Coverage Gap cost-sharing applies to all drugs on the designated tier. Drugs that are covered in the coverage gap also receive the donut hole discount.
(P) Coverage Gap cost-sharing applies to only some of drugs on the designated drug tier. Drugs that are covered in the coverage gap also receive the donut hole discount.
Go to the AARP MedicareRx Preferred (PDP) 2021 Formulary Browser by choosing a letter below:
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