Types of UnitedHealthcare Plans

Medicare Prescription Drug (Part D) Plans

Get help covering the cost of your prescription drugs. A Medicare Prescription Drug (Part D) plan can help cover the costs of your medication.

What do Medicare Prescription Drug plans cover?

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.

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

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.

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 you or 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.

How can I get the best value from my Medicare Prescription Drug plan?

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 within the plan’s preferred network.

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Use a specialty pharmacy to help manage more chronic or complex conditions such as cancer, rheumatoid arthritis or multiple sclerosis.
Specialty pharmacies, like BriovaRx*, provide additional support for members through convenient deliveries, 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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AARP^® Medicare Supplement Insurance Plans

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.

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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.

Medicare Advantage plans and Medicare Prescription Drug plans

Plans are insured through United Healthcare 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 must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/ coinsurance may change on January 1 of each year.

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