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.

BlueRx
Option 1 (PDP)

$73.70 per month

Enroll Now

BlueRx
Option 2 (PDP)

$124.70 per month

Enroll Now

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. 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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