If you are a member of a Myaarpmedicare (your coverage is provided through a former employer, union group or trust) and looking for MyAarpMedicare Drug List 2022,This posthas information about the drugs covered by this plan.
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 October 1, 2021.
To get updated information about the covered drugs or if you have questions, please call UnitedHealthcare Customer Service. Our contact information is on the cover.
How can I find a drug on the drug list?
There are 2 ways to find your prescription drugs in this drug list:
- By name. Turn to the section “Covered drugs by name (Drug index)” on pages 12-30 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 the section “Covered drugs by category” on pages 31-95. The drugs in this drug list are grouped into categories depending on the type of medical condition they are used to treat. 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 (B) drugs in bold type (for example, Humalog) and generic (G) 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. 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. Our contact information is on the cover.
Drug tier Includes
Tier 1: Lower-cost, commonly used generic drugs. Preferred generic
Tier 2: Many generic drugs.
Tier 3: Many common brand name drugs, called Preferred brand preferred brands and some higher-cost generic drugs.
Select Insulin Drugs* Select Insulin Drugs with $35 max copay through gap.
Tier 4: Non-preferred generic and non-preferred brand Non-preferred drug name drugs.
Tier 5: Unique and/or very high-cost brand and generic Specialty tier drugs.
* For 2022, this plan participates in the Part D Senior Savings Model which offers lower, stable, and predictable out of pocket costs for covered insulin through the different Part D benefit coverage stages. You will pay a maximum of $35 for a 1-month supply of Part D select insulin drugs 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 Coverage stage. This cost sharing only applies to members who do not qualify for a program that helps pay for your drugs (“Extra Help”).
In addition, your plan has added coverage of some prescription drugs that are not normally covered under Medicare Part D. Please see the section “Additional covered drugs” on page 127 for a list of these drugs.
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 category” chart starting on page 31. 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 call UnitedHealthcare Customer Service. Our contact information is on the cover.
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. Our contact information, along with the date we last updated the drug list, is on the cover.
If you find out that your drug is not covered, you can do either of the following options:
- 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 make an exception and 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 request for an expedited review is 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. For more information about exceptions, please review your Evidence of Coverage.
We may cover your drug in certain cases during the first 90 days of your membership. The following chart shows how much of your drug we may cover while you ask for an exception.
If you… And you are… We may cover…
are a new member in the first 90 days not in a nursing home or at least a 30-day of your membership long-term care facility temporary supply ORin a nursing home or at least a 31-day were a member last year and it’s the first long-term care facility temporary supply 90 days of your plan year in a nursing home or at least a 31-day have been in the plan for more than long-term care facility and emergency supply 90 days need a supply right away
are going through a change in your level not in a nursing home or at least a 30-day of care, such as being transferred from a long-term care facility temporary supply hospital to a long-term care facility, any in a nursing home or at least a 31-day time during the year long-term care facility temporary supply
The prescription must be filled at a network pharmacy. If your prescription is written for fewer days, we’ll allow refills to provide at least the day supply listed in the chart above. (Note: The long-term care pharmacy may provide the drug in smaller amounts at a time to prevent waste.)
We will not pay for more of your drug after you get this temporary or emergency supply unless you receive authorization from the plan.
Can the drug list change?
Most changes in drug coverage happen on January 1. We may need to make changes during the plan year for safety or other reasons that can affect you. We must follow the Medicare rules in making these changes.
Changes that can affect you this year
- New generic drugs. We may immediately remove a brand name drug on our drug list if we are replacing it with a new generic drug that will appear on the same or lower cost sharing tier and with the same or fewer restrictions. Also, when adding the new generic drug, we may decide to keep the brand name drug on our drug list, but immediately move it to a different cost sharing tier or add new restrictions.
If you are currently taking that brand name drug, we may not tell you in advance before we make that change, but we will later provide you with information about the specific change(s) we have made.
- Other changes. We may make other changes that affect members currently taking a drug. For instance, we may add a generic drug that is not new to market to replace a brand name drug currently on the drug list; or add new restrictions to the brand name drug or move it to a different cost sharing tier or both. Or, we may make changes based on new clinical guidelines. If we remove drugs from our drug list, add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost sharing tier, we must notify affected members of the change.
We will notify members at least 30 days before the change becomes effective, or when the member requests a refill of the drug, at which time you will receive at least a 30-day supply of the drug.
If we add new generic drugs or make other changes, you or your prescriber can ask us to make an exception and continue to cover the brand name drug for you. The notice we provide you will also include information on how to request an exception, and you can also find information in the section “How can I get an exception?” on page 8.
- Drugs removed from the market. If the Food and Drug Administration (FDA) says a drug you are taking is not effective or is unsafe, we will let you know and take it off the drug list right away.
Changes that will not affect you if you are currently taking the drug
Usually, if you’re taking a drug on this drug list that was covered at the beginning of the year, we will not remove or reduce coverage during the year except as described above. You will not get a notice this year about changes that do not affect you. However, on January 1 of the next year these changes will affect you, therefore it is important to check the drug list for any changes to drugs for the new plan year.
Drugs with dosages other than a 1-month supply
Drugs packaged in an extended day supply
Some drugs are packaged from the manufacturer to provide more than a 1-month supply. When you fill these drugs, you may have to pay more than 1 copay/coinsurance for a single prescription. For more information, please call Customer Service. Our contact information is on the cover.
Daily cost sharing for oral medications filled for less than a 1-month supply
A daily cost sharing rate may apply when your doctor prescribes less than a full month’s supply of certain drugs for you and you are required to pay a copay. A daily cost sharing rate is the copay divided by the number of days in a month’s supply.
Daily cost sharing applies only if the drug is in the form of a solid oral dose (e.g., tablet or capsule) when dispensed for a supply of less than 1-month under applicable law. The daily cost sharing requirements do not apply to either of the following:
- Solid oral doses of antibiotics.
- Solid oral doses that are dispensed in their original container or are usually dispensed in their original packaging to help patients comply with usage and dosage directions.