2021 North Carolina Medicare Part D Prescription Drug Plan Highlights

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2021 North Carolina Stand-Alone Prescription Drug Plan Highlights
CMS PDP Region 8
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Lowest Premium Medicare Part D Plan (PDP) in North Carolina
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Plan Name Plan ID			Monthly Prem.	Dedu- ctible	(Donut Hole) Additional Gap Coverage	Preferred Pharmacy Copay/Coinsurance 30-Day Supply		Total Formulary Drugs
SilverScript SmartRx (PDP) (S5601-183) Benefits & Contact Info			$7.20	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $19.00 Preferred Brand: $46.00 Non-Preferred Drug: 48% Specialty Tier: 25%		3,562 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:

Lowest Premium $0 Deductible NC Prescription Drug Plan (PDP)
Click here to see all North Carolina $0 deductible PDP plans by premium lowest to highest

Plan Name Plan ID			Monthly Prem.	Dedu- ctible	Additional Gap Coverage	Preferred Pharmacy Copay/Coinsurance		Total Drugs
SilverScript Plus (PDP) (S5601-017) Benefits & Contact Info			$61.60	$0	Yes, some additional gap coverage.	Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%		3,058 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:

Five (5) Most Popular Medicare Part D Plans (PDP) in North Carolina
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Plan Name Plan ID			Monthly Prem.	Dedu- ctible	Additional Gap Coverage	Preferred Pharmacy Copay/Coinsurance		State Members
SilverScript Choice (PDP) (S5601-016) Benefits & Contact Info			$25.10	$330	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 27%		141,635 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
AARP MedicareRx Preferred (PDP) (S5820-007) Benefits & Contact Info			$86.00	$0	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $5.00 Generic: $10.00 Preferred Brand: $45.00 Non-Preferred Drug: 40% Specialty Tier: 33%		66,689 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Humana Basic Rx Plan (PDP) (S5884-133) Benefits & Contact Info			$27.70	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 25%		61,655 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Humana Premier Rx Plan (PDP) (S5884-154) Benefits & Contact Info			$65.30	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: $45.00 Non-Preferred Drug: 49% Specialty Tier: 25%		47,114 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Medicare Rx Saver (PDP) (S5810-042) Benefits & Contact Info			$26.50	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: 35% Specialty Tier: 25%		46,708 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:

North Carolina Medicare Prescription Drug Plans (PDP) Under $30
Click here for all NC Medicare Prescription Drug plans

Plan Name Plan ID			Monthly Prem.	Dedu- ctible	Additional Gap Coverage	Preferred Pharmacy Copay/Coinsurance		Total Drugs
SilverScript SmartRx (PDP) (S5601-183) Benefits & Contact Info			$7.20	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $19.00 Preferred Brand: $46.00 Non-Preferred Drug: 48% Specialty Tier: 25%		3,562 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Clear Spring Health Premier Rx (PDP) (S6946-034) Benefits & Contact Info			$13.90	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: $40.00 Non-Preferred Drug: 41% Specialty Tier: 25%		3,270 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Elixir RxPlus (PDP) (S7694-128) Benefits & Contact Info			$14.30	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $6.00 Preferred Brand: $43.00 Non-Preferred Drug: 45% Specialty Tier: 25%		3,229 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Wellness Rx (PDP) (S4802-177) Benefits & Contact Info			$15.30	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $6.00 Preferred Brand: $43.00 Non-Preferred Drug: 48% Specialty Tier: 25% insulin coverage $35 or less		3,463 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Value Script (PDP) (S4802-143) Benefits & Contact Info			$17.20	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $7.00 Preferred Brand: $43.00 Non-Preferred Drug: 49% Specialty Tier: 25% insulin coverage $35 or less		3,463 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Humana Walmart Value Rx Plan (PDP) (S5884-187) Benefits & Contact Info			$17.20	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $4.00 Preferred Brand: 17% Non-Preferred Drug: 35% Specialty Tier: 25%		3,160 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Cigna Secure-Essential Rx (PDP) (S5617-287) Benefits & Contact Info			$23.00	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: 18% Non-Preferred Drug: 42% Specialty Tier: 25%		3,109 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Clear Spring Health Value Rx (PDP) (S6946-005) Benefits & Contact Info			$24.70	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $3.00 Preferred Brand: $42.00 Non-Preferred Drug: 33% Specialty Tier: 25%		3,248 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Classic (PDP) (S4802-081) Benefits & Contact Info			$24.90	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $30.00 Non-Preferred Drug: 35% Specialty Tier: 25%		3,088 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Cigna Secure Rx (PDP) (S5617-217) Benefits & Contact Info			$24.90	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $2.00 Preferred Brand: $30.00 Non-Preferred Drug: 50% Specialty Tier: 25% Select Care Drugs: $0.00		3,146 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Mutual of Omaha Rx Premier (PDP) (S7126-077) Benefits & Contact Info			$25.00	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $2.00 Preferred Brand: 23% Non-Preferred Drug: 45% Specialty Tier: 25% insulin coverage $35 or less		2,917 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
SilverScript Choice (PDP) (S5601-016) Benefits & Contact Info			$25.10	$330	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Drug: 40% Specialty Tier: 27%		3,012 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Elixir RxSecure (PDP) (S7694-008) Benefits & Contact Info			$26.00	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $7.00 Preferred Brand: 15% Non-Preferred Drug: 32% Specialty Tier: 25%		3,168 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Medicare Rx Select (PDP) (S5810-282) Benefits & Contact Info			$26.40	$365	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $3.00 Preferred Brand: $47.00 Non-Preferred Drug: 42% Specialty Tier: 26%		3,463 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Express Scripts Medicare - Saver (PDP) (S5660-224) Benefits & Contact Info			$26.50	$285	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Generic: $7.00 Preferred Brand: $35.00 Non-Preferred Drug: 50% Specialty Tier: 28% insulin coverage $35 or less		2,918 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
WellCare Medicare Rx Saver (PDP) (S5810-042) Benefits & Contact Info			$26.50	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $40.00 Non-Preferred Drug: 35% Specialty Tier: 25%		3,088 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
AARP MedicareRx Saver Plus (PDP) (S5921-353) Benefits & Contact Info			$26.50	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $1.00 Generic: $6.00 Preferred Brand: $34.00 Non-Preferred Drug: 40% Specialty Tier: 25%		3,104 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Exemplar Health Basic (PDP) (S9325-002) Benefits & Contact Info			$27.10	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $2.00 Generic: $6.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25%		3,189 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:
Humana Basic Rx Plan (PDP) (S5884-133) Benefits & Contact Info			$27.70	$445	No additional gap coverage, only the Donut Hole Discount	Preferred Generic: $0.00 Generic: $1.00 Preferred Brand: 20% Non-Preferred Drug: 35% Specialty Tier: 25%		3,057 Browse Formulary
Higher cost-sharing at non-preferred pharmacies. Click for details:

A few notes to help with the understanding of the 2021 Medicare Part D Plan chart above. Plan Name: This is the official plan name from the Centers for Medicare and Medicaid Services (CMS). The same plan name generally has a different plan id in each state. Plan ID: This is the unique id for this particular plan. Monthly Premium: This is the amount you must pay each month to use the plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase. Deductible: The standard CMS plan initial deductible is $445. Many Medicare plans do not have a deductible; however their plan premium may be higher. Gap Coverage: In the CMS Standard Plan, the beneficiary, or others on their behalf (e.g. the brand-name drug manufacturer discount), pay(s) up to $5,184 in drug costs, depending on your mix of generics and brand-name drugs. The Healthcare Reform provides that for plan year 2021, all formulary drugs will have at least a 75% discount in the coverage gap (Donut Hole). The Gap Coverage Types discussed in this section are supplemental coverage your plan pays in addition to the Healthcare Reform mandated discounts. In our chart, you will see one of the following: No Gap Coverage: You receive the 75% Donut Hole Discount and pay up to $5,184 depending on your mix of generics and brand-name drugs, before exiting into Catastrophic Coverage. Read more... Yes: This plan offers some supplemental gap coverage in addition to the 75% Donut Hole Discount. See plan details for a description of the gap coverage. The description may read similar to: Under this plan you may pay even less for the brand and generic drugs on the formulary. Your cost varies by tier. You will need to use your formulary to locate your drug's tier. See the chart that follows to find out how much it will cost you. Copay / Coinsurance - Cost Sharing - This is what you will pay for formulary drugs in the Initial Coverage Phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on the drug’s tier. Plans can form their own tiers, so you should contact the plan or reference their summary of benefits to find out what copays and limitations are associated with each tier. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. * When the text "insulin coverage $35 or less" appears, this Part D plan may offer particular forms of insulin as part of the Senior Savings Model.  The Senior Savings Model stipulates that some insulin will cost no more than $35 in the deductible, initial coverage, and coverage gap phases of your Part D plan. Please contact the drug plan for more details. Total Formulary Drugs (default) - This is the total number of medications on the plans formulary or drug list. This total drug count does not include "Bonus Drugs". These are non-Medicare Part D drugs which are covered by the plan, however they do not count toward your plan deductible, retail drug cost, or TrOOP. (Chart Source: Centers for Medicare and Medicaid file 2021 PDP Landscape Source file) Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, we cannot guarantee the accuracy of this information. Through the application process we will provide you with the most up-to-the-minute information/pricing. Top