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2024 Medicare Part D Plan’s Negotiated Retail Drug Price

 Below you will find the average negotiated retail prescription drug price for your chosen Medicare Part D or Medicare Advantage plan, along with, tier cost-sharing details, your estimated cost for purchases during each coverage phase, tier cost-sharing details and your costs with explanations, and plan’s retail drug price history.
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2024 Medicare Prescription Drug Price Information
AARP Medicare Rx Basic from UHC (PDP) (S5921-349-0)
Benefits & Contact Info         
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less.

Click on a letter below to view the
AARP Medicare Rx Basic from UHC (PDP) Formulary
A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  0-9 
This Plan Uses Lower Cost-Sharing for Preferred Pharmacies
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin]  
Plan’s average negotiated retail drug price in
CMS PDP Region 4, includes: NJ 		$41.52* 30-Day Supply
$124.55* 90-Day Supply
Formulary (Drug List) drug tier:Tier #3: Preferred Brand
Does this plan offer any Gap coverage?No Gap Coverage
Does this drug have Gap coverage?No, this drug IS NOT covered in the gap, but all drugs receive the donut hole discount.
Drug Usage Management Restrictions:None
Formulary (Drug List) Tier Cost-Sharing Details
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less.
  30-Day Supply
Cost-Sharing		 90-Day Supply
Cost-Sharing
Preferred Pharmacy Standard Pharmacy Mail- Order** Preferred Pharmacy Standard Pharmacy Mail- Order**
Initial $545 Deductible Cost Sharing:
 100% 100% n/a 100% 100% 100%
Initial Coverage Phase Cost-Sharing:
 16% 16% n/a 16% 16% 16%
Coverage Gap Phase Cost-Sharing Incl. Donut Hole Discount (Generics 75%):
 25% 25% n/a 25% 25% 25%
Coverage Gap Phase Cost-Sharing Incl. Donut Hole Discount (Brand 75%):
 25% 25% n/a 25% 25% 25%
Catastrophic Coverage Phase Cost-Sharing (all Formulary Drugs):
 $0$0n/a $0$0$0
Your Estimated Cost for Purchases During Each Coverage Phase
  30-Day Supply
Cost-Sharing		 90-Day Supply
Cost-Sharing
Preferred Pharmacy Standard Pharmacy Mail- Order** Preferred Pharmacy Standard Pharmacy Mail- Order**
Your Estimated Cost in Deductible Phase:
 $41.52 $41.52 n/a $124.55 $124.55 $124.55
Your Estimated Cost Initial Coverage Phase:
 $6.64 $6.64 n/a $19.93 $19.93 $19.93
Your Estimated Cost in Gap if Drug is Generic (75% discount):
 $10.38$10.38n/a $31.14$31.14$31.14
Your Estimated Cost in Gap if Drug is Brand-Name (75% discount):
 $10.38$10.38n/a $31.14$31.14$31.14
Your Estimated Cost in Catastrophic Coverage (all Formulary Drugs):
 $0$0n/a $0$0$0
Tier Cost-Sharing Details and Your Costs with Explanations
  30-Day Supply
Cost-Sharing		 90-Day Supply
Cost-Sharing
Preferred Pharmacy Standard Pharmacy Mail- Order** Preferred Pharmacy Standard Pharmacy Mail- Order**
--- If you purchase during the Initial Deductible Phase ---
Initial $545 Deductible Cost Sharing:
 100% 100% n/a 100% 100% 100%
Your Estimated Cost in Deductible Phase:
 $41.52 $41.52 n/a $124.55 $124.55 $124.55
Explanation for 30-Day Preferred Pharmacy purchase:
 In the initial deductible phase, you will pay 100% of the drug cost up to your deductible limit of $545. Any excess would fall into the initial coverage phase.
--- If you purchase during the Initial Coverage Phase ---
Initial Coverage Phase Cost-Sharing:
 16% 16% n/a 16% 16% 16%
Your Estimated Cost Initial Coverage Phase:
 $6.64 $6.64 n/a $19.93 $19.93 $19.93
Explanation for 30-Day Preferred Pharmacy purchase:
 The cost-sharing for purchases made during the initial coverage phase (ICP) would be $6.64 or ($41.52 x 16%).
--- If you purchase during the Coverage Gap Phase (Donut Hole) ---
Your Estimated Cost in Gap if Drug is Generic (75% discount):
 $10.38$10.38n/a $31.14$31.14$31.14
Explanation for 30-Day Preferred Pharmacy purchase:
 Your cost is the negotiated retail price of $41.52 x 25%.
Your Estimated Cost in Gap if Drug is Brand-Name (75% discount):
 $10.38$10.38n/a $31.14$31.14$31.14
Explanation for 30-Day Preferred Pharmacy purchase:
 Your costs is the negotiated retail price of $41.52 x 25%.
--- If you purchase during the Catastrophic Coverage Phase ---
Catastrophic Coverage Phase Cost-Sharing (all Formulary Drugs):
 $0$0n/a $0$0$0
Your Estimated Cost in Catastrophic Coverage (all Formulary Drugs):
 $0$0n/a $0$0$0
Explanation for 30-Day Preferred Pharmacy purchase:
 Beginning with plan year 2024, the Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing once your TrOOP reaches $8,000 -- the established maximum cap on out-of-pocket spending for Part D formulary drugs (RxMOOP).
AARP Medicare Rx Basic from UHC (PDP)
Average Negotiated Retail Drug Price History
 30-Day Supply90 Day Supply
June, 2024: $41.52$124.55
March, 2024: $41.52$124.55
January, 2024: $41.52$124.55
September, 2023: $38.65$115.96
June, 2023: $38.60$115.80
March, 2023: $38.60$115.80
January, 2023: $38.60$115.80
September, 2022: $38.80$116.40
June, 2022: $38.80$116.40
March, 2022: $38.80$116.40
January, 2022: $38.80$116.40
September, 2021: $39.60$118.80
June, 2021: $39.60$118.80
March, 2021: $39.60$118.80
January, 2021: $39.60$118.80
September, 2020: $39.60$118.80
June, 2020: $39.60$118.80
March, 2020: $39.60$118.80
January, 2020: $39.60$118.80
September, 2019: $40.44$119.63
June, 2019: $37.67$111.30
March, 2019: $32.77$96.62
January, 2019: $32.76$96.62
September, 2018: $24.30$71.57
June, 2018: $22.70$66.77
March, 2018: $11.76$34.02
January, 2018: $12.86$37.32
September, 2017: $39.54$117.42
June, 2017: $39.53$117.42
March, 2017: $39.85$118.38
January, 2017: $12.80$37.24
September, 2016: $12.83$37.26
June, 2016: $12.83$37.26
April, 2016: $12.83$37.26
January, 2016: $12.61$36.61
September, 2015: $12.95$37.46
June, 2015: $14.94$43.44
April, 2015: $24.98$73.55
January, 2015: $24.98$73.55
September, 2014: $73.50$218.03
June, 2014: $73.47$217.95
March, 2014: $78.10$231.85
January, 2014: $77.92$231.31
October, 2013: $77.96$231.35
January, 2013: $77.95--
April, 2012: n/a--
September, 2010: n/a--
Notes:
*The Medicare drug plan’s average negotiated retail drug price is based on several variables: the medication, the quantity of your prescription, the specific Medicare Part D plan, and the pharmacies in the plan’s service area. In this case, the average of the AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin] prices that the AARP Medicare Rx Basic from UHC (PDP) has negotiated with each of the retail pharmacies in the plan’s service area (CMS PDP Region 4, includes: NJ). In other words, when you use the AARP Medicare Rx Basic from UHC (PDP) to purchase AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin], you may pay slightly more or slightly less than the figures shown in the table above depending on the pharmacy where you fill your prescription and the quantity of your prescription. The example average retail prices used above are based on a quantity of 20 for the 30-day supply and a quantity of 60 for the 90-day supply.

**The mail-order cost-sharing is the plan’s "preferred" mail-order cost-sharing.

Return to the AARP Medicare Rx Basic from UHC (PDP) 2024 Formulary Browser by choosing a letter below:
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Chart Legend:

What does all this mean? Below are a few notes to help you understand the above 2024 Medicare Part D AARP Medicare Rx Basic from UHC (PDP) Plan Formulary.




 
 


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