You have a choice of two coverage options:

BlueRx Option I

  • Covers most Medicare-approved prescription drugs.
  • Has a lower monthly premium with a $405 deductible in 2018 that must be met before benefits begin.


BlueRx Option II

  • Covers most Medicare-approved prescription drugs, with more extensive formulary vs. Option 1.
  • There is no deductible. You pay as little as $2 per prescription from the start.

Both plans save you money if you get prescriptions filled at select pharmacies. Not only will you pay less for a 30-day supply of medication, but you can get a 90-day supply of your prescription drugs with just two times the copay. It's like getting 30 days for FREE.

2018 Plan Benefits

BlueRx
Option 1 (PDP)

$73.70 per month

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BlueRx
Option 2 (PDP)

$124.70 per month

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Deductible
Deductible $405 $0
Preferred Cost-Sharing Pharmacy Copays/Coinsurance
Preferred Cost-Sharing Pharmacy Copays/Coinsurance
Tier 1 – Preferred Generic
Tier 1 – Preferred Generic $1 $2
Tier 2 – Non-Preferred Generic
Tier 2 – Generic $4 $8
Tier 3 – Preferred Brand
Tier 3 – Preferred Brand $37 $37
Tier 4 – Non-Preferred Brand
Tier 4 – Non-Preferred Brand 40% 40%
Tier 5 – Speciality Tier
Tier 5 – Speciality Tier 25% 33%
Standard Cost-Sharing Pharmacy Copays/Coinsurance
Standard Cost-Sharing Pharmacy Copays/Coinsurance
Tier 1 – Preferred Generic
Tier 1 – Preferred Generic $11 $12
Tier 2 – Non-Preferred Generic
Tier 2 – Generic $14 $18
Tier 3 – Preferred Brand
Tier 3 – Preferred Brand $47 $47
Tier 4 – Non-Preferred Brand
Tier 4 – Non-Preferred Brand 50% 50%
Tier 5 – Speciality Tier
Tier 5 – Speciality Tier 25% 33%
Coverage Gap Phase
Coverage Gap Phase Once the TOTAL prescription annual spending exceeds $3,750 and YOUR spending is below $5,000, you pay 44% of generic drug costs and 35% of brand-name drug costs.
Catastrophic Coverage Phase
Catastrophic Coverage Phase Once YOUR out-of-pocket spending on prescriptions reaches $5,000, you pay the greater of $3.35 for generic drugs and $8.35 for brand-name drugs OR 5% coinsurance per prescription for the rest of the year. BlueRx pays the rest.

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. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary. 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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