2022 Medicare Prescription Drug Plan Cost-Sharing Details

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2022 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
AARP MedicareRx Saver Plus (PDP) (S5921-376-0)
Benefits & Contact Info        
This plan is available in CMS PDP Region 32

Click on a letter below to view the
AARP MedicareRx Saver Plus (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
All Formulary Drug Tiers: 100% 100% 100% 100% 100% 100%
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $1.00 $6.00 n/a $3.00 $18.00 $3.00
Tier 2: Generic: $5.00 $10.00 n/a $15.00 $30.00 $15.00
Tier 3: Preferred Brand: $38.00 $43.00 n/a $114.00 $129.00 $114.00
Tier 4: Non-Preferred Drug: 40% 40% n/a 40% 40% 40%
Tier 5: Specialty Tier: 25% 25% 25% n/a n/a n/a
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 $3.95 The greater of 5% or $3.95
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $9.85 The greater of 5% or $9.85
Go to the AARP MedicareRx Saver Plus (PDP) 2022 Formulary Browser by choosing a letter below:
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