Medicare Prescription Drug Plans

Formularies (Drug Lists)

A formulary, or drug list, is a list of drugs covered by your Medicare Part D plan benefit. A drug list may also be referred to as a covered medications list (CML), a preferred drug list (PDL), a select drug list or a formulary. These drugs are dispensed through participating pharmacies to covered members. Drug lists may differ between Medicare prescription drug plans.

To view a plan's complete formulary or drug list (PDF), go to View plans and pricing, enter your ZIP code and select one of the AARP® MedicareRx Plans insured through UnitedHealthcare. The drug list may change during the plan year. Additions or deletions made to drug lists will be posted along with the effective date in the 60-day formulary change notice section below. For complete formulary information, look up prescription drugs.

You may view and print any of the forms. Note: Adobe® Reader® software is required to download these documents. It's free and easy.

2014 Prior authorization criteria

The plan requires you or your doctor to get prior authorization for certain drugs. This means the plan needs more information from your doctor to make sure the drug is being used correctly for a medical condition covered by Medicare. If you don't get approval, the plan may not cover the drug. To view your plan's prior authorization criteria to determine if your drugs qualify for coverage, go to View plans and pricing, enter your ZIP code and select a specific plan with prescription drug benefits. You can find the 2014 Prior Authorization Criteria (PDF) in the Helpful Resources section of the Plan Details page.

2014 Step therapy criteria

There are effective, lower-cost drugs that treat the same medical condition as this drug. You may be required to try one or more of these other drugs before the plan will cover your drug. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.

To view your plan's step therapy criteria to determine if your drugs qualify for coverage, go to View plans and pricing, enter your ZIP code and select a specific plan with prescription drug benefits. You can find the 2014 Step Therapy Criteria (PDF) in the Helpful Resources section of the Plan Details page.

60-day formulary change notice

Notice of Formulary Changes will be posted 60 days prior to the removal or change in the preferred or tiered cost-sharing status of a Medicare Part D drug. The posting will include:

  • The name of the affected covered Medicare Part D drug.
  • Information on whether the drug is being removed from the drug list or changing its preferred or tiered cost-sharing status.
  • The reason why the drug is being removed from the drug list or changing it's preferred or tiered cost-sharing status.
  • Alternative drugs in the same therapeutic category, class or cost-sharing tier and the expected cost-sharing for that drug.
  • Information for members on how to obtain an updated coverage determination or an exception to a coverage determination.

Note: You will also be notified in your Explanation of Benefits (EOB) about a drug list change 60 days before it takes effect.

Formulary Changes
If you're a continuing member in the plan, you'll receive an Annual Notice of Changes(ANOC). You may notice that a formulary medication you are currently taking is either not on the upcoming year's formulary or its cost-sharing or coverage is limited in the upcoming year. If your drug has been removed from the formulary or has a new requirement and limit that you must follow, the plan will send you a separate communication to notify you.

Formulary deletions update

Formulary additions update

View the Transition Process - AARP MedicareRx Plans.

Learn more about coverage determinations and appeals, drug conditions and limitations and quality assurance policies.

Find Medicare Prescription Drug Plans in Your Area

Questions?

Call UnitedHealthcare at:

1-877-699-5710 (TTY 711)

Hours: 8 a.m. - 8 p.m. local time, 7 days a week.

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Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental plan (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage, vision and hearing coverage and fitness programs.

Creditable Coverage

Refers to prescription drug coverage that offers benefits the same as or better than coverage available through Medicare.

Tier 1: Preferred Generic. Lowest Copay.

This tier includes lower-cost, commonly used generic drugs. Use Tier 1 drugs for the lowest out-of-pocket costs.

Tier 2: Non-Preferred Generic. Low Copay.

This tier includes most generic drugs. Use Tier 2 drugs, instead of Tier 3 or 4, to help reduce your out-of-pocket costs.

Tier 5 : Specialty Tier. Coinsurance.

This tier includes unique and/or very high-cost drugs. You pay a percentage of the total drug cost, called coinsurance.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Tier 3: Preferred Brand. Medium Copay.

This tier includes many common brand name drugs, called preferred brands, and some higher-cost generic drugs. Many Tier 3 drugs have lower-cost options in Tier 1 or 2. Ask your doctor if they could work for you.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Drug List tool tip

A list of drugs covered by your Medicare Part D plan. A drug list may also be referred to as a covered prescription drugs list (CML), a preferred drug list (PDL), a select drug list or a formulary. These drugs are dispensed through participating network pharmacies to covered members. Drug lists may differ between Medicare prescription drug plans.


Carefully weigh the differences in drug lists against the plan costs and other features when choosing a plan that may best meet your needs. A drug list may change during the year.

Tier 2: Low Copay

This tier includes most generic drugs. Use Tier 2 drugs, instead of drugs in Tiers 3 or 4 to help reduce your out-of-pocket costs.

Coverage Gap Stage:

During the Coverage Gap Stage, you (or others on your behalf) will pay no more than 72% of the total cost for generic drugs or 47.5% of the total cost for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $4,550 in year-to-date out-of-pocket costs.

You may pay less if your plan has better coverage in the gap.

Always use your Medicare Part D member ID card during the coverage gap to get the plan's discounted drug rates. The money you spend using your card counts toward your out-of-pocket costs.

Out-of-Pocket Costs:

The amount you (or others pay on your behalf) pay for prescription drugs starting January 1, 2013 not including premiums.

Premium (or monthly premium)

The monthly fee you pay for Medicare coverage.

Deductible/annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drug costs before Medicare or the plan begins to pay.

Deductible/Annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drugs costs before the insurance company or Medicare begins to pay.

Coinsurance

A kind of cost sharing where you pay a percentage of the cost of a service. For example, a plan might pay 75% and you would pay 25%. In Medicare Advantage, coinsurance varies depending on the plan.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an annual check-up.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an office visit.

Primary Care Physician's name and ID

Your primary care physician (PCP) plays an important role in your health care, and we want you to have the opportunity to select one you are comfortable with. Your PCP can:

  • Help you make good lifestyle choices to maintain and improve your health.
  • Serve as a direct point of contact in case of an emergency.
  • Manage the drugs prescribed to you and identify potential adverse interactions.
  • Coordinate the care of specialists who may diagnose and treat your conditions.
  • Help ensure that you are getting the care you need while helping to minimize your out-of-pocket costs.

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