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2024 Medicare Part D Plan’s Negotiated Retail Drug Price
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2024 Medicare Prescription Drug Price Information
Mutual of Omaha Rx Essential (PDP) (S7126-115-0)
Benefits & Contact Info         
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less.

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Mutual of Omaha Rx Essential (PDP) Formulary
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This Plan Uses Lower Cost-Sharing for Preferred Pharmacies
ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA]  
Plan’s average negotiated retail drug price in
CMS PDP Region 13, includes: MI 		$541.20* 30-Day Supply
$1,623.60* 90-Day Supply
Formulary (Drug List) drug tier:Tier #4: Non-Preferred Drug
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:Prior Authorization and Quantity Limit:120/30Days
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% 100% n/a n/a n/a
Initial Coverage Phase Cost-Sharing:
 48% 50% 48% n/a n/a n/a
Coverage Gap Phase Cost-Sharing Incl. Donut Hole Discount (Generics 75%):
 25% 25% 25% n/a n/a n/a
Coverage Gap Phase Cost-Sharing Incl. Donut Hole Discount (Brand 75%):
 25% 25% 25% n/a n/a n/a
Catastrophic Coverage Phase Cost-Sharing (all Formulary Drugs):
 $0$0$0 n/an/an/a
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:
 $541.20 $541.20 $541.20 n/a n/a n/a
Your Estimated Cost Initial Coverage Phase:
 $259.78 $270.60 $259.78 n/a n/a n/a
Your Estimated Cost in Gap if Drug is Generic (75% discount):
 $135.30$135.30$135.30 n/an/an/a
Your Estimated Cost in Gap if Drug is Brand-Name (75% discount):
 $135.30$135.30$135.30 n/an/an/a
Your Estimated Cost in Catastrophic Coverage (all Formulary Drugs):
 $0$0$0 n/an/an/a
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% 100% n/a n/a n/a
Your Estimated Cost in Deductible Phase:
 $541.20 $541.20 $541.20 n/a n/a n/a
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:
 48% 50% 48% n/a n/a n/a
Your Estimated Cost Initial Coverage Phase:
 $259.78 $270.60 $259.78 n/a n/a n/a
Explanation for 30-Day Preferred Pharmacy purchase:
 The cost-sharing for purchases made during the initial coverage phase (ICP) would be $259.78 or ($541.20 x 48%).
--- If you purchase during the Coverage Gap Phase (Donut Hole) ---
Your Estimated Cost in Gap if Drug is Generic (75% discount):
 $135.30$135.30$135.30 n/an/an/a
Explanation for 30-Day Preferred Pharmacy purchase:
 Your cost is the negotiated retail price of $541.20 x 25%.
Your Estimated Cost in Gap if Drug is Brand-Name (75% discount):
 $135.30$135.30$135.30 n/an/an/a
Explanation for 30-Day Preferred Pharmacy purchase:
 Your costs is the negotiated retail price of $541.20 x 25%.
--- If you purchase during the Catastrophic Coverage Phase ---
Catastrophic Coverage Phase Cost-Sharing (all Formulary Drugs):
 $0$0$0 n/an/an/a
Your Estimated Cost in Catastrophic Coverage (all Formulary Drugs):
 $0$0$0 n/an/an/a
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).
Mutual of Omaha Rx Essential (PDP)
Average Negotiated Retail Drug Price History
 30-Day Supply90 Day Supply
March, 2024: $541.20$1,623.60
January, 2024: $541.20$1,623.60
September, 2023: $7,168.80$21,812.11
June, 2023: $7,168.80$21,812.40
March, 2023: $7,168.80$21,812.40
January, 2023: $7,168.80$21,812.40
September, 2022: n/an/a
June, 2022: n/an/a
March, 2022: n/an/a
January, 2022: n/an/a
September, 2021: n/an/a
June, 2021: n/an/a
March, 2021: n/an/a
January, 2021: n/an/a
September, 2020: n/an/a
June, 2020: n/an/a
March, 2020: n/an/a
January, 2020: n/an/a
September, 2019: 
June, 2019: 
March, 2019: 
January, 2019: 
September, 2018: 
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September, 2017: 
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September, 2015: 
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September, 2014: 
June, 2014: 
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January, 2014: 
October, 2013: 
January, 2013: --
April, 2012: --
September, 2010: --
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 ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA] prices that the Mutual of Omaha Rx Essential (PDP) has negotiated with each of the retail pharmacies in the plan’s service area (CMS PDP Region 13, includes: MI). In other words, when you use the Mutual of Omaha Rx Essential (PDP) to purchase ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA], 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 120 for the 30-day supply and a quantity of 360 for the 90-day supply.

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

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What does all this mean? Below are a few notes to help you understand the above 2024 Medicare Part D Mutual of Omaha Rx Essential (PDP) Plan Formulary.