Mutual of Omaha Rx Premier (PDP)
S7126 - 075 - 0
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Mutual of Omaha Rx Premier (PDP) is a Medicare Part D Prescription Drug Plan by Mutual of Omaha Rx.
This page features plan details for 2023 Mutual of Omaha Rx Premier (PDP) S7126 – 075 – 0.
IMPORTANT: This page has been updated with plan and premium data for 2023.
Locations
Mutual of Omaha Rx Premier (PDP) is offered in the following locations.
Plan Overview
Mutual of Omaha Rx Premier (PDP) offers the following coverage and cost-sharing.
| Insurer: | Mutual of Omaha Rx |
| Drugs Covered: | Yes |
Please Note:
- This plan does not charge an annual deductible for all drugs. The $505 annual deductible only applies to drugs on certain tiers.
Ready to sign up for Mutual of Omaha Rx Premier (PDP) ?
Get help from a licensed insurance agent.
Click to Call 1-877-354-4611 TTY 711.
Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.
Drug Info
Mutual of Omaha Rx Premier (PDP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $505.00 |
| Initial Coverage Limit: | $4,660.00 |
| Catastrophic Coverage Limit: | $7,400.00 |
| Drug Benefit Type: | Enhanced Alternative |
| Gap Coverage: | Yes |
| Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs. The table below shows how the LIS impacts the Part D premium of this plan.| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $71.40 | $68.10 | $64.90 | $61.60 | $58.40 |
Initial Coverage Phase
After you pay your $505.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $1.00 copay | $8.00 copay | ||
| 2 (Generic) | $10.00 copay | $17.00 copay | ||
| 3 (Preferred Brand) | $45.00 copay | $47.00 copay | ||
| 4 (Non-Preferred Drug) | 45% | 47% | 45% | 47% |
| 5 (Specialty Tier) | 25% | 25% | 25% | 25% |
60 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | ||||
| 2 (Generic) | ||||
| 3 (Preferred Brand) | ||||
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) |
90 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $3.00 copay | $24.00 copay | $2.50 copay | $2.50 copay |
| 2 (Generic) | $30.00 copay | $51.00 copay | $25.00 copay | $25.00 copay |
| 3 (Preferred Brand) | $135.00 copay | $141.00 copay | $112.50 copay | $112.50 copay |
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) |
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.
30 Day
90 Day
30 Day
90 Day
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | $4.15 copay or 5% (whichever costs more) |
| Brand-name drugs | $10.35 copay or 5% (whichever costs more) |
Ready to sign up for Mutual of Omaha Rx Premier (PDP) ?
Get help from a licensed insurance agent.
Click to Call 1-877-354-4611 TTY 711.
Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.