You have a choice of three coverage options:

BlueRx Essential

  • Lowest monthly premium
  • $415 deductible
  • Copays as low as $1


BlueRx Enhanced

  • $350 deductible
  • Copays as low as $1
  • Covers more brand-name drugs


BlueRx Enchanced Plus

  • $0 deductible
  • Copays as low as $2
  • Covers more brand-name drugs


Mail-Order Pharmacy Service

No matter which BlueRx plan you choose, you can get prescriptions delivered right to your door. You can get a 90-day supply of routine medications but pay only the copay for a 60-day — and shipping is free!

2019 Plan Benefits

BlueRx
Essential (PDP)

$34.40 per month

Enroll Now

BlueRx
Enhanced (PDP)

$71.50 per month

Enroll Now

BlueRx
Enhanced Plus (PDP)

$119.90 per month

Enroll Now
Deductible
Deductible $415 $350 $0
Preferred Cost-Sharing Pharmacy Copays/Coinsurance
Preferred Cost-Sharing Pharmacy Copays/Coinsurance
Tier 1 – Preferred Generic
Tier 1 – Preferred Generic N/A $1 $2
Tier 2 – Non-Preferred Generic
Tier 2 – Generic N/A $4 $8
Tier 3 – Preferred Brand
Tier 3 – Preferred Brand N/A $40 $40
Tier 4 – Non-Preferred Drug
Tier 4 – Non-Preferred Drug N/A 45% 45%
Tier 5 – Speciality Tier
Tier 5 – Speciality Tier N/A 25% 33%
Standard Cost-Sharing Pharmacy Copays/Coinsurance
Standard Cost-Sharing Pharmacy Copays/Coinsurance
Tier 1 – Preferred Generic
Tier 1 – Preferred Generic $1 $8 $9
Tier 2 – Non-Preferred Generic
Tier 2 – Generic $4 $11 $15
Tier 3 – Preferred Brand
Tier 3 – Preferred Brand $47 $47 $47
Tier 4 – Non-Preferred Drug
Tier 4 – Non-Preferred Drug 50% 50% 50%
Tier 5 – Speciality Tier
Tier 5 – Speciality Tier 25% 25% 33%
Coverage Gap Phase
Coverage Gap Phase Once the TOTAL prescription annual spending exceeds $3,820 and YOUR spending is below $5,100, you pay 37% of generic drug costs and 25% of brand-name drug costs.
Catastrophic Coverage Phase
Catastrophic Coverage Phase Once YOUR out-of-pocket spending on prescriptions reaches $5,100, you pay the greater of $3.40 for generic drugs and $8.50 for brand-name drugs OR 5% coinsurance per prescription for the rest of the year. BlueRx pays the rest.

BlueRx
Essential (PDP)

$34.40 per month

Enroll Now

BlueRx
Enhanced (PDP)

$71.50 per month

Enroll Now

BlueRx
Enhanced Plus (PDP)

$119.90 per month

Enroll Now

This information is not a complete description of benefits. Call 1-855-828-3982 (TTY 711)* for more information. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary. To the extent of any discrepancy between this web site and your Evidence of Coverage/Contract Booklet, your Evidence of Coverage/Contract Booklet takes priority. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call 1-800-MEDICARE ( 1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; The Social Security Office at 1-800-772-1213 (TTY  1-800-325-0778), between 7 a.m. and 7 p.m., Monday through Friday; or your Medicaid Office.

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