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Home / Medicare Education / Medicare Prescription Drug (Part D) Plans

Types of UnitedHealthcare Plans

Medicare Prescription Drug (Part D) Plans

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[[state-start:MP,OR,VI]] Get help covering the cost of your prescription drugs. A Medicare prescription drug (Part D) plan can help cover the costs of your medication. [[state-end]]
[[state-start:null,AL,AK,AS,AZ,AR,CA,CO,CT,DE,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NC,ND,NY,OH,OK,PA,PR,RI,SC,SD,TN,TX,UT,VT,VA,WA,DC,WV,WI,WY]] Get help covering the cost of your prescription drugs. A Medicare prescription drug (Part D) plan can help pay for your medication. [[state-end]]

What do Medicare prescription drug plans cover?

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All Medicare Prescription Drug plans cover the types of drugs most often prescribed for people enrolled in Medicare. This is decided by the U.S. government. But it's up to each plan which specific brand name and generic drugs they will cover within those types. You can find this information by viewing a plan's drug list.

 

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Medicare prescription drug (Part D) plans cover the types of drugs most often prescribed for people enrolled in Medicare. This is decided by the federal government. Every Part D plan has specific brand name and generic drugs it covers within those types.

 

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Video Transcript (PDF)

 

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What should I know about a plan’s drug list?

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A drug list—sometimes called a formulary—is a list of drugs covered by a plan.

  • A drug list can change from year to year.

    Part D plans may add or remove drugs from their drug list each year. Changes may also be made during the year, for example if a drug is taken off the market. Your plan will let you know if a change affects a drug you are taking.
  • Many Part D plans have a tiered drug list where drugs are divided into groups based on cost.

    In general, drugs on low tiers cost you less than drugs on high tiers. Plans may charge a deductible for certain drug tiers and not for others, or the deductible amount may be different depending on the tier.
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A drug list (also called a formulary) tells you what drugs covered by a plan.

  • A drug list can change from year to year.

    Part D plans can add or remove drugs from their drug list each year. The list can also change for other reasons. For example, if a drug is taken off the market. Your plan will let you know if there's a coverage change to a drug you're taking.
  • Many Part D plans have a tiered drug list.

    Tiers divide drugs into groups based on cost. In general, drugs in low tiers cost you less than drugs in high tiers. Sometimes plans charge deductibles for certain drug tiers.
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Drug list tiers:

Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
$ (Lowest cost)
$$
$$$
$$$$
$$$$$ (Highest cost)
Tier 1
$ (Lowest cost)
Tier 2
$$
Tier 3
$$$
Tier 4
$$$$
Tier 5
$$$$$ (Highest cost)

 

What does it mean if my prescription drug has a requirement or limitation?

There are rules for some prescription drugs that limit how and when a plan will cover them. These are called requirements or limitations. If you don't follow these rules or don't get permission from the plan saying you don't have to (called an exception), you may have to pay the full cost of the drug out of your own pocket. You can find out if a drug has any requirements or limitations by looking for the following abbreviations next to the drug names in a plan's drug list:

PA – Prior Authorization

The plan needs you or your doctor to get prior authorization before they will agree to pay for this drug. This means the plan needs more information from your doctor about how the drug is going to be used.

QL – Quantity Limits

The plan will cover only a certain amount of this drug or type of drug for one copay or over a certain number of days. For example, the plan may only let you have 30 pills per month of a certain drug.

ST – Step Therapy

There may be lower-cost drugs that work just as well for a medical condition such as this one. The plan might want you to try one or more of these other drugs before it will cover the drug that costs more.

B/D – Medicare Part B or Medicare Part D Coverage Determination

Depending on how this drug is used, it may be covered by either Medicare Part B (doctor and outpatient health care) or Medicare Part D (prescription drugs). Your doctor might need to give the plan more information about how this drug will be used to make sure it’s being covered by the right part of Medicare.

ISSP - Insulin Senior Savings Program

You will pay a maximum of $35 for a 1-month supply of insulin during the deductible, initial coverage and coverage gap or "donut hole" stages of your benefit. You will pay 5% of the cost of your insulin in the catastrophic stage. Your cost may be less if you receive Extra Help from Medicare.

Plans have rules that limit how and when they cover certain drugs. These rules are called requirements or limitations. You need to follow the rules to avoid paying the full cost of the drug out-of-pocket. If needed, you and your doctor can also ask the plan for an exception.

Here are the requirements and limitations you may see on a drug list:

PA – Prior Authorization

The plan needs more information from your doctor about how the drug is going to be used before it will pay.

QL – Quantity Limits

The plan will cover only a certain amount of a drug or type of drug for one copay or over a certain number of days. 

ST – Step Therapy

The plan wants you to try one or more lower-cost alternative drugs before it will cover the drug that costs more.

B/D – Medicare Part B or Medicare Part D Coverage Determination

Some drugs can be covered by either Medicare Part B (doctor and outpatient health care) or Medicare Part D (prescription drugs). The plan needs more information about how a drug will be used to make sure it’s covered by the right part of Medicare.

ISSP - Insulin Senior Savings Program

You will pay a maximum of $35 for a 1-month supply of insulin during the deductible, initial coverage and coverage gap or "donut hole" stages of your benefit. You will pay 5% of the cost of your insulin in the catastrophic stage. Your cost may be less if you receive Extra Help from Medicare.

 

How can I get the best value from my Medicare prescription drug plan?

[[state-start:MP,OR,VI]]

Here are some suggestions to help you make sure your Medicare Prescription Drug plan is a good fit for your health care and budget needs.

  • Know the drug list:

    Make sure the medication you take is on a plan’s drug list. If it’s not, check with your provider to see if there’s one on the drug list you can switch to.
  • Consider generics:

    Ask your provider about generic or low‑cost options for drugs in high tiers or that are expensive.
  • Show your member ID card:

    Be sure you show your member ID card when you fill prescriptions. That way, you'll be sure to get any cost savings available to plan members.
  • Use the mail order pharmacy:

    You may be able to save money when you get at least a 3-month supply of your medication delivered to your home.
  • Use a preferred network pharmacy:

    Many plans offer cost savings if you fill your prescriptions at a pharmacy that's part of the plan’s preferred network.
[[state-end]]
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  • Know the drug list.

    Make sure your medication is on a plan’s drug list. If it’s not, check with your provider to see if there’s one on the drug list you can switch to.
  • Consider generics.

    Ask your provider about generic or low‑cost options to replace higher-tier or more expensive drugs.
  • Show your member ID card.

    Be sure to show your member ID card when filling prescriptions to get any member cost savings.
  • Use the mail order pharmacy.

    Convenient home delivery of your regular, maintenance medications can save time and money.
  • Use a preferred network pharmacy.

    Many plans offer cost savings if you fill your prescriptions at a pharmacy that's part of the plan’s preferred network.
[[state-start:AL,AK,AS,AZ,AR,CA,CO,CT,DE,GA,HI,IA,KS,KY,LA,ME,MA,MI,MN,MS,MT,MP,NE,NV,NM,NC,ND,NY,OK,PR,RI,SC,SD,TN,UT,VT,VI,WA,DC,WV,WI,WY]]
  • Use a specialty pharmacy to help manage more chronic or complex conditions.

    Specialty pharmacies, like BriovaRx*, provide extra support through expert care and personalized connections.

*BriovaRx is an affiliate of UnitedHealthcare Insurance Company. You are not required to use BriovaRx as your specialty pharmacy.

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Read Next:

Enrollment Basics

Medicare Prescription Drug Plans | AARP Medicare Plans

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Hours: 7 a.m. – 11 p.m. ET, Monday – Friday, 9 a.m. – 5 p.m. ET, Saturday.

[[state-end]

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Call UnitedHealthcare: 1-855-264-3796 (TTY 711)

Hours: 7 a.m. – 11 p.m. ET, Monday – Friday, 9 a.m. – 5 p.m. ET, Saturda

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View Important Disclosures Below

UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers.

AARP® encourages you to consider your needs when selecting products and does not make product recommendations for individuals.

Please note that each insurer has sole financial responsibility for its products.

AARP® Medicare Supplement Insurance Plans

AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company.

Insured by UnitedHealthcare Insurance Company, Horsham, PA (UnitedHealthcare Insurance Company of New York, Islandia, NY for New York residents). Policy form No. GRP 79171 GPS-1 (G-36000-4).

In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.

Not connected with or endorsed by the U.S. Government or the federal Medicare program.

This is a solicitation of insurance. A licensed insurance agent/producer may contact you.

You must be an AARP member to enroll in an AARP Medicare Supplement Plan.

THESE PLANS HAVE ELIGIBILITY REQUIREMENTS, EXCLUSIONS AND LIMITATIONS. FOR COSTS AND COMPLETE DETAILS (INCLUDING OUTLINES OF COVERAGE), CALL A LICENSED INSURANCE AGENT/PRODUCER AT THE TOLL-FREE NUMBER ABOVE.

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Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan's contract renewal with Medicare. You do not need to be an AARP member to enroll in a Medicare Advantage plan or Medicare Prescription Drug plan.

This information is not a complete description of benefits. Contact the plan for more information.

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WB26626ST

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WB26626ST (07-19)

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WB26626AK

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