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2024 Medicare Part D Plan’s Negotiated Retail Drug Price
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2024 Medicare Prescription Drug Price Information
AARP Medicare Rx Walgreens from UHC (PDP) (S5921-403-0)
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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AARP Medicare Rx Walgreens from UHC (PDP) Formulary
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This Plan Uses Lower Cost-Sharing for Preferred Pharmacies
AYVAKIT 100 MG TABLET  
Plan’s average negotiated retail drug price in
CMS PDP Region 22, includes: TX 		$39,123.65* 30-Day Supply
$117,370.95* 90-Day Supply
Formulary (Drug List) drug tier:Tier #5: Specialty Tier
Does this plan offer any Gap coverage?Yes
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:30/30Days
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 $410 Deductible Cost Sharing:
 100% 100% 100% n/a n/a n/a
Initial Coverage Phase Cost-Sharing:
 27% 27% 27% 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:
 $3,326.51 $3,326.51 $3,326.51 n/a n/a n/a
Your Estimated Cost Initial Coverage Phase:
 $3,105.97 $3,105.97 $3,105.97 n/a n/a n/a
Your Estimated Cost in Gap if Drug is Generic (75% discount):
 $8,000.00$8,000.00$8,000.00 $8,000.00n/an/a
Your Estimated Cost in Gap if Drug is Brand-Name (75% discount):
 $2,105.26$2,105.26$2,105.26 $2,000.00n/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 $410 Deductible Cost Sharing:
 100% 100% 100% n/a n/a n/a
Your Estimated Cost in Deductible Phase:
 $3,326.51 $3,326.51 $3,326.51 n/a n/a n/a
Explanation for 30-Day Preferred Pharmacy purchase:
  For a purchase of this drug made during the initial deductible phase, you cross over into other phases of your plan’s coverage (straddle claim).   So you pay 100% of the drug cost up to your deductible of $410 and the remaining amount ($39,123.65-$410) (price - deductible) falls into your initial coverage phase (ICP).   For the ICP portion of your coverage, your cost-sharing would be an additional $1,247.40 or $4,620.00 x 27% (overage up to your remaining coverage limit ($4,620.00) * cost-sharing). Since the amount of the retail drug price falling into the ICP $38,713.65 is greater than the remaining initial coverage limit $4620 ( - $410), $34,093.65 rolls into the coverage gap phase. For the portion that falls into the coverage gap phase, you would pay an additional $1,669.11 or ($6,676.42 x 25% -- 70% of the discount counts toward TrOOP and the 5% paid by your plan does not count toward TrOOP assuming this is a brand-name drug). Since the portion of the costs that fell into the coverage gap $34,093.65 x 95% exceeds the amount of TrOOP left ($6,342.60), $27,417.23 falls into the catastrophic coverage phase. For the portion that falls into the catastrophic coverage phase, you would pay an additional $0.00 or $0.00 which is greater than $0.00($sharing30P of $27,417.23).
--- If you purchase during the Initial Coverage Phase ---
Initial Coverage Phase Cost-Sharing:
 27% 27% 27% n/a n/a n/a
Your Estimated Cost Initial Coverage Phase:
 $3,105.97 $3,105.97 $3,105.97 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 $1,358.10 or ($5,030.00 x 27%). But since the retail drug price ($39,123.65) is greater than initial coverage limit (), the difference of $34,093.65 rolls into the coverage gap phase. For the portion that falls into the coverage gap phase, you would pay an additional $1,747.87 or ($6,991.47 x 25% -- 70% of the discount counts toward TrOOP and the 5% paid by your plan does not count toward TrOOP). The portion of the costs that fell into the coverage gap $6,991.47 exceeds the amount of TrOOP left ($6,641.90) so you only pay in the gap on the amount within the TrOOP. The excess over TrOOP, $27,102.18 falls into the catastrophic coverage phase. For the portion that falls into the catastrophic coverage phase, you would pay an additional $0.00 or $0.00 which is greater than $0.00 ($0.00 of $27,102.18). So, your total cost for this one purchase is $3,105.97 or $1,358.10 (ICP) + $1,747.87 (Gap) + $0.00 (Cat.Cov.).
--- If you purchase during the Coverage Gap Phase (Donut Hole) ---
Your Estimated Cost in Gap if Drug is Generic (75% discount):
 $8,000.00$8,000.00$8,000.00 $8,000.00n/an/a
  Since this drug’s negotiated retail price ($39,123.65) is greater than the TrOOP limit ($8,000), in the donut hole phase, you would pay $8,000.00 ($32,000.00 x 25%) plus $0.00 in the catastrophic phase, because is greater than $0.00 ($0.00 of $7,123.65). Although it rarely happens that you would be responsible for the entire $8,000 for a purchase in the coverage gap, it can occur, for example on an expensive generic drug with a $0 copay in the initial coverage phase.
Your Estimated Cost in Gap if Drug is Brand-Name (75% discount):
 $2,105.26$2,105.26$2,105.26 $2,000.00n/an/a
  Since 95% this drug’s negotiated retail price ($39,123.65) is greater than the TrOOP limit ($8,000), in the donut hole phase, you would pay $2,105.26 (($8,000 / 95%) x 25% -- 70% of the discount counts toward TrOOP and the 5% paid by your plan does not count toward TrOOP) plus $0.00 in the catastrophic phase, $0.00 because $0.00 is greater than $0.00 ($0.00 of $30,702.60).  Although it rarely happens that you would be responsible for the entire $8,000 for a purchase in the coverage gap, it can occur, for example on an expensive generic drug with a $0 copay in the initial coverage phase.
--- 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).
AARP Medicare Rx Walgreens from UHC (PDP)
Average Negotiated Retail Drug Price History
 30-Day Supply90 Day Supply
March, 2024: $39,123.65$117,370.95
January, 2024: $37,296.56$111,889.69
September, 2023: $39,722.68$116,517.15
June, 2023: $39,582.90$116,026.20
March, 2023: $39,477.60$115,634.70
January, 2023: $37,458.60$109,720.80
September, 2022: $37,703.70$110,833.20
June, 2022: $37,703.70$110,833.20
March, 2022: $37,703.70$110,833.20
January, 2022: $35,986.20$105,730.20
September, 2021: $35,614.80$104,840.10
June, 2021: $35,630.10$104,841.91
March, 2021: $35,628.60$104,641.20
January, 2021: $33,882.30$99,566.10
September, 2020: $33,553.80$97,816.50
June, 2020: $33,553.80$97,816.50
March, 2020: n/an/a
January, 2020: n/an/a
September, 2019: 
June, 2019: 
March, 2019: 
January, 2019: 
September, 2018: 
June, 2018: 
March, 2018: 
January, 2018: 
September, 2017: 
June, 2017: 
March, 2017: 
January, 2017: 
September, 2016: 
June, 2016: 
April, 2016: 
January, 2016: 
September, 2015: 
June, 2015: 
April, 2015: 
January, 2015: 
September, 2014: 
June, 2014: 
March, 2014: 
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 AYVAKIT 100 MG TABLET prices that the AARP Medicare Rx Walgreens from UHC (PDP) has negotiated with each of the retail pharmacies in the plan’s service area (CMS PDP Region 22, includes: TX). In other words, when you use the AARP Medicare Rx Walgreens from UHC (PDP) to purchase AYVAKIT 100 MG TABLET, 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 30 for the 30-day supply and a quantity of 90 for the 90-day supply.

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

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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 Walgreens from UHC (PDP) Plan Formulary.