www.myaarpmedicare.com drug list 2020-2021

If you are a member of a group sponsored plan (your coverage is provided through a former employer, union group or trust), please call the Customer Service number on the back of your UnitedHealthcare member ID card.

What is a drug list?

A drug list, or formulary, is a list of prescription drugs covered by your plan. Your plan and a team of health care providers work together in selecting drugs that are needed for well-rounded care and treatment.Your plan will generally cover the drugs listed in our drug list as long as:·

  • The drug is used for a medically accepted indication,·
  • The prescription is filled at a network pharmacy and·
  • Other plan rules are followed.

For more information about your drug coverage, please review your Evidence of Coverage.

Note to existing members:

This complete list of prescription drugs covered by your plan is current as of February 1, 2020.

For an up-to-date list of covered drugs or if you have questions, please call UnitedHealthcareCustomer Service. Our contact information is on the cover.

www.myaarpmedicare.com drug list 2020

This drug list has changed since last year. Please review this document to make sure your prescription drugs are still covered. In most cases, you must use network pharmacies to have your prescriptions covered by the plan.When this drug list refers to “we,”“us,” or “our,” it means UnitedHealthcare.

When it refers to “plan,”“our plan,” or “your plan,” it means AARP MedicareRx Walgreens (PDP) Plans.

How do I use the drug list?

There are 2 ways to find your prescription drugs in this drug list:

  1. By name. Turn to section “Covered drugs by name (Drug index)” on pages 12–26 to see the …….list of drug names in alphabetical order. Find the name of your drug. The page number where …….you can find the drug will be next to it.
  2. By medical condition. Turn to section “Covered drugs by medical condition” on pages …….27–81 to look for drugs based on your medical conditions. For example, if you have a heart …….condition, you should look in the category Cardiovascular Agents. This is where you will find …….drugs that treat heart conditions.

Can’t find your drug?

Check the complete drug list by visiting our plan website at www.myAARPMedicare.com. You can use online tools to look up your drugs. This information is updated on a regular basis.

What are generic drugs?

Generic drugs have the same active ingredients as brand name drugs. They usually cost less than brand name drugs and are approved by the Food and Drug Administration (FDA). Our plan covers both brand name and generic drugs.

Talk with your doctor to see if any of the brand name drugs you take have generic versions. Then review the drug list to make sure you are getting the drug you need for the least amount of money.

The drug list shows brand name drugs in bold type (for example, Humalog) and generic drugs in plain type (for example, Simvastatin).

What is a compounded drug?

A compounded drug is created by a pharmacist by combining or mixing ingredients to create a prescription medication customized to the needs of an individual patient. Generally compounded drugs are non-formulary drugs (not covered) by your plan. You may need to ask for and receive an approved coverage determination from us to have your compounded drug covered. Compounded drugs may be Part D eligible. For more information about compounded drugs, please review your Evidence of Coverage.

Drug payment stage and drug tiers

The amount you pay for a covered prescription drug will depend on:·

  • Your drug payment stage. Your plan has different stages of drug coverage. When you fill a prescription, the amount you pay depends on the coverage stage you’re in.·
  • Your drug’s tier. Each covered drug is in 1 of 5 drug tiers. Each tier has a copay or coinsurance amount. The chart below shows the differences between the tiers.

If you need help or have any questions about your drug costs, please review your Evidence of Coverage or call UnitedHealthcare Customer Service.

  • Tier 1:Preferred genericLower-cost, commonly used generic drugs.
  • Tier 2:GenericMany generic drugs.
  • Tier 3:Preferred brandMany common brand name drugs, called preferred brands and some higher-cost generic drugs.
  • Tier 4:Non-preferred drugNon-preferred generic and non-preferred brand name drugs.
  • Tier 5:Specialty tierUnique and/or very high-cost brand and generic drugs.

Getting Extra Help

If you qualify for Extra Help paying for your prescription drugs, your copays and coinsurance may be lower. Members who qualify for Extra Help will receive the “Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs” (LIS Rider). Please read it to learn about your costs. You can also call UnitedHealthcare Customer Service. Our contact information is on the cover.

Are there any rules or limits on my drug coverage?

Yes, some drugs may have coverage rules or have limits on the amount you can get. If your drug has any coverage rules or limits, there will be a code(s) in the “Coverage rules or limits on use”column of the “Covered drugs by medical condition” chart starting on page 27. The codes and what they mean are shown below and on the next page.

You can also get more information about the coverage rules and/or limits applied to specific covered drugs by visiting our website. We have posted online documents that explain our prior authorization and step therapy restrictions. If you would like a copy sent to you, please callUnitedHealthcare Customer Service. Our contact information is on the cover.

Coverage Rules and Limits

PA – Prior authorization

The plan requires you or your doctor to get prior approval 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.

QL – Quantity limits

The plan will cover only a certain amount of this drug for 1 copay or over a certain number of days. These limits may be in place to ensure safe and effective use of the drug. If your doctor prescribes more than this amount or thinks the limit is not right for your situation, you or your doctor can ask the plan to cover the additional quantity.

ST – Step therapy

There may be effective, lower-cost drugs that treat the same medical condition as this drug. You may be required to try 1 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 or your doctor can ask the plan to cover this drug.

Other Special Coverage Rules

B/D – Medicare Part B or Part D

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 may need to provide the plan with more information about how this drug will be used to make sure it’s correctly covered by Medicare.

LA – Limited access

Drugs are considered “limited access” if the FDA says the drug can be given out only by certain facilities or doctors. These drugs may require extra handling, provider coordination or patient education that can’t be done at a network pharmacy.

MME – Morphine milligram equivalent

Additional quantity limits may apply across all drugs in the opioid class used for the treatment of pain. This additional limit is called a cumulative morphine milligram equivalent (MME), and is designed to monitor safe dosing levels of opioids for individuals who may be taking more than 1 opioid drug for pain management. If your doctor prescribes more than this amount or thinks the limit is not right for your situation, you or your doctor can ask the plan to cover the additional quantity.

7D – 7-Day limit

An opioid drug used for the treatment of acute pain may be limited to a 7-day supply for members with no recent history of opioid use. This limit is intended to minimize long-term opioid use. For members who are new to the plan, and have a recent history of using opioids, the limit may be overridden by having the pharmacy contact the plan.

DL – Dispensing limit

Dispensing limits apply to this drug. This drug is limited to a 1 month supply per prescription.

You and your doctor may ask the plan for an exception to the coverage rules and/or limits for your drug. See section “How can I get an exception?” on page 8 or see your Evidence of Coverage to learn more.

If you don’t get approval from the plan before you fill a prescription for a drug with coverage rules or limits, you may have to pay the full cost of the drug.

What if my drug is not on this list?

If your drug is not included in this drug list we may still cover it. Call UnitedHealthcare Customer Service to ask if it’s covered. Or go to www.myAARPMedicare.com to look it up online. The information is updated on a regular basis.

If you find out that your drug is not covered, you can do 1 of these things:

  1. Ask UnitedHealthcare Customer Service for a list of similar drugs that are covered by the plan. When you get the list, show it to your doctor and ask him or her to prescribe a covered drug.
  2. .Ask the plan to makean exceptionand cover your drug. Review the next section for more exception information.

How can I get an exception?

Sometimes you may need to ask for drug coverage that’s not normally provided by your plan. This is called asking for an exception. When you do, the plan will review your request and give you a coverage decision known as a coverage determination.

Types of exceptions you can ask for

  • Drug list exception: Ask the plan to cover your drug even if it’s not on the drug list. If approved, this drug will be covered at a pre-determined cost-sharing level. You will not be able to ask us to provide the drug at a lower cost-sharing level.
  • Utilization exception: Ask the plan to revise the coverage rules or limits on your drug. For example, if your drug has a quantity limit, you can ask the plan to change the limit and cover more.
  • Tiering exception:Ask the plan to cover your drug on our list at a lower cost-sharing level if this drug is not on the specialty tier. If approved this would lower the amount you pay out-of-pocket for your drug.

The plan may approve your request for an exception if the covered alternative drugs wouldn’t be as effective in treating your condition or would cause adverse medical effects.

Who can ask for an exception?

You, your authorized representative or your doctor can ask for an exception by calling UnitedHealthcare Customer Service. Your doctor must give us a supporting statement with the reason for the exception.

How long does it take to get an exception?

After we get the statement from your doctor supporting your request for an exception, we’ll give you a decision within 72 hours. You can ask for an expedited (fast) decision if you or your doctor believes that your health could be seriously harmed by waiting 72 hours. If your expedited requestis approved, we’ll give you a decision within 24 hours after we get your doctor’s supporting statement.

Can I get my drug while I wait for an exception?

As a new or continuing member in our plan, we may cover a temporary supply of your drug if it’s not on our drug list or if it has rules or limits. For example, you may need a prior authorization from us before you can fill your prescription. During the time when you are getting a temporary supply, you should talk with your doctor to decide if there is a similar drug on the drug list you can take instead. If you and your doctor decide this is the only drug that will work for you, you will need to ask for an exception. We may cover your drug in certain cases during the first 90 days of your membership.

MAPD Medicare Plans – What Are MAPD Plans in Medicare?

Private medical health insurance corporations administer Medicare Advantage Prescription Drug (MAPD) plans. They combine Medicare components A, B, and D beneath one policy.

Medicare Advantage Prescription Drug (MAPD) plans seek advice from Medicare Advantage plans that consists of prescription drug coverage.

Original Medicare includes Part A, hospitalization coverage, and Part B, outpatient medical insurance. Medicare Advantage plans are an alternative option.

All Medicare Advantage plans provide elements A and B benefits. However, a number of the plans additionally consist of prescription drug coverage and other advantages, such as dental and imaginative and prescient.

Below, we have a look at Medicare Part D, as well as the types of Medicare Advantage plans.

We talk about the variations between Medicare Advantage plans that have prescription drug insurance and people that do not.

Lastly, we examine the fees of Medicare Advantage and the assist to be had to pay for the plan.

We may also use a few terms in this piece that can be helpful to recognize while deciding on the high-quality insurance plan:

Deductible: This is an annual amount that someone has to spend out of pocket within a sure term earlier than an insurer starts to fund their remedies.
Coinsurance: This is a percentage of a remedy value that someone will want to self-fund. For Medicare Part B, this comes to 20%.
Copayment: This is a fixed dollar amount that an insured character can pay while receiving certain remedies. For Medicare, this generally applies to prescription drugs.

What is Medicare Part D?

There are two approaches for human beings with Medicare to get prescription drug coverage. One way is through a Medicare Advantage plan that consists of coverage of prescribed medication.

Another way, which is to be had for a person with authentic Medicare, is thru a Medicare Part D plan.

In each of those cases, Part D plans offer a set trendy of coverage. Each plan has a formulary, that’s a listing of prescription drugs that the policy covers. Formularies range among insurers.

In most cases, Medicare does no longer allow a person with a Medicare Advantage plan to shop for a separate Part D plan. However, Medicare may additionally make an exception if a person has a Medicare Advantage plan that doesn’t provide prescription drug coverage.

What is Medicare Advantage?

Medicare Advantage (MA) plans, additionally called Medicare Part C, is a collection of insurance plans administered by non-public health insurance groups. Medicare pays those corporations to offer individuals with components A and B advantages.

MA and coverage for prescribed medicine

MA plans also can provide prescription drug insurance. Plans that include cover for prescribed medicine are sometimes called MAPD plans.

Many MA and MAPD plans offer extra advantages that Original Medicare does not. Common blessings encompass dental, imaginative and prescient, and listening to care. Also, well-being programs consisting of gymnasium memberships will be an introduced benefit.

MA and MAPD plans have much less flexibility than authentic Medicare inside the desire of healthcare carriers. While a person with unique Medicare can also use any provider that accepts Medicare, most of the people with an MA plan ought to use an in-network company.

Types of Medicare Advantage plans

There are numerous kinds of MA plans. The 4 major plans include:

  • Health Maintenance Organization (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Private Fee-for-Service (PFFS) plans
  • Special Needs Plans (SNP)

Two much less common kinds are HMO Point of Service (HMO-POS) and Medicare Savings Account (MSA) plans.

Health Maintenance Organization (HMO) plans

Most HMO plans require a person to select in-community healthcare carriers.

Exceptions to these encompass events when someone desires emergency care, pressing care, or out-of-region dialysis care.

Although a few plans allow a person to visit out-of-network carriers, it usually costs less to go to those in the network.

HMO plans typically include prescription drug insurance.

Most plans require a referral to see an expert.

HMO Point of Service plans

HMO-POS plans permit individuals to get a few offerings from out-of-network vendors. These plans require better coinsurance or copayment.

Preferred Provider Organizations (PPO) plans

A man or woman with a PPO plan has the ability to pick out either in-network or out-of-network docs and hospitals. As with HMO plans, the in-network vendors normally priceless.

Most PPO plans cowl prescription drugs.

The plans typically do no longer require a referral to peer an expert.

PPO plans usually offer benefits that authentic Medicare does no longer.

Private Fee-for-Service plans

The non-public coverage enterprise administering a PFFS plan will set the quantity they pay for medical doctors, hospitals, and different healthcare companies. The insurer may also set the quantity that someone will pay closer to their healthcare charges.

An individual is loose to choose between in-community or out-of-network carriers, however, once more, an in-network issuer is normally extra fee-effective.

Some PFFS plans cover prescribed drugs.

The plans do not require a referral to peer a specialist.

Special Needs Plans

An SNP customizes benefits, healthcare issuer options, and drug formularies to satisfy the wishes of a person with certain persistent sicknesses, together with diabetes, coronary heart disease, or dementia.

The guidelines of the plan require someone to use in-network providers except they want emergency care, pressing care, or out-of-vicinity dialysis.

The blessings of SNPs consist of prescription drug coverage.

The plans do now not require a referral to look a consultant.

Medicare Savings Account plans

MSA plans work in a different way from different Advantage plans.

Medicare deposits a certain amount of money into a person’s financial institution account, and that they use the money to pay for healthcare prices for the duration of the year.

MSA plans do not encompass cover for prescribed drugs.

Medicare Advantage expenses

According to the Kaiser Family Foundation, the average month-to-month premium for a Medicare Advantage plan in 2019 turned into $29. The cost of the charges can range from $0 to greater than $100.

The Part B month-to-month top rate in 2020 is $144.60 per month. A man or woman won’t ought to pay this premium as there are plans that pay some, if not all, of the price.

Some MA plans may have two deductibles, which includes a deductible for the plan and deductible for prescription drug coverage.

They might also have distinct copayments or coinsurance, but all of the plans positioned a restriction on yearly out-of-pocket charges.

In all cases, charges can be affected by whether or not someone uses in-network vendors and how many more advantages they pick out.
Because Medicare applications have deductible, copayment, and coinsurance fees, out-of-pocket fees may be excessive.

Some individuals with a Medicare Advantage plan can be eligible for Medicaid, which is open to human beings with both original Medicare or Medicare Advantage.

Medicaid enables pay healthcare prices for a person who meets the qualifying earnings and aid requirements. If a person has Medicare plus full Medicaid, most in their health care charges are usually included.

Summary

An MAPD plan is a Medicare Advantage plan that has prescription drug coverage.

MAPD plans consist of Medicare elements A, B, and D advantages.

People might also pick from numerous types of plans, such as HMO, PPO, PFFS, and SNP plans.

The features and guidelines fluctuate a few of the styles of plans, and the fees range substantially.

A character inquisitive about an MAPD plan may want to examine the special factors, regulations, and prices of the plans cautiously before creating a desire.

The information in this website may also assist you in making non-public decisions about coverage, however, it isn’t always meant to provide advice regarding the purchase or use of any insurance or coverage products. Healthline Media does no longer transact the enterprise of coverage in any manner and is not certified as an insurance agency or producer in any U.S. Jurisdiction. Healthline Media does now not endorse or endorse any 1/3 parties that could transact the commercial enterprise of insurance.