• Plan Name: This is the official Medicare Part D prescription drug plan or Medicare Advantage name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region). The plan name is followed by the plan type (PDP, HMO, HMO-POS, PPO, PFFS, etc.)
  
  
• Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase.
  
  
• Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase.
  • Many Medicare Part D plans use the standard $615 deductible as provided in the CMS Standard plan design.
  • Some Part D plan providers offer an initial deductible lower than the Standard deductible.
  • Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.
  • *Some Part D plans exclude some drug tiers from the deductible. If the deductible field above is followed by * (example: $615*), then this drug tier is excluded from the deductible.
  
  
  
• Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
  • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have five (5) tiers 1=Preferred Generics, 2=Generics, 3=Preferred Brands, 4=Non-preferred Brands, 5=Specialty Drugs.
  • Tier Number* - Some Part D drug plans exclude one or more drug tiers from the plan’s deductible. If the drug tier field above is followed by * (example: 2*), then this drug tier is excluded from the plan’s deductible.
  • Tier Description - This is the Medicare Part D plan’s description of this particular drug tier.
  
  
• Cost Sharing - Copay / Coinsurance - 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 your maximum cap on out-of-pocket spending for Part D formulary drugs - RxMOOP. 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. The drug Tier is shown to the left of this column. There are two figures shown under this "Cost Sharing" category:
  • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the initial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $2,100) at a "Preferred" network pharmacy. In most cases, the "Preferred" network pharmacy cost-sharing is lower than the standard (non-preferred) network pharmacy cost-sharing.
    
    
    
    
  • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  
  
• Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
  • None - This drug does not fall under any drug utilization management controls.
  • P - Prior Authorization -This drug is subject to prior authorization.
  • S - Step Therapy -This drug is subject to step therapy.
  • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.
  
  
  
• Plan’s Avg. Retail Drug Price: This is the Medicare Part D prescription drug plan’s average negotiated retail drug price. This price is calculated for each plan by averaging the negotiated retail price for a particular drug across all pharmacies in the plan’s service area. For example, the negotiated retail drug price for Quetiapine Fumarate 25MG Tables on the AARP Medicare Rx Saver from UHC plan in Florida (S5921-356) is determined by averaging all of the AARP MedicareRx Saver Plus plan’s negotiated retail drug prices for a Florida pharmacies.

(Chart Source: Centers for Medicare and Medicaid files: CMS Formulary Data August 2026, CMS Pricing Data July 2026)

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, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Medicare plan provider.