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Florida Blue Medicare Prescription Drug

BlueMedicare Complete Rx (PDP) 2024

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Initial Coverage:

 
tooltip_Until yearly drug costs reach $3,310, you'll pay..._2022

Coverage Gap

 
tooltip_After costs paid by you and the drug plan are greater than $3,310 and your out-of-pocket is less than $4,850, you'll pay..._2022

Catastrophic Coverage

 
tooltip_After your out-of-pocket costs plus the amount of the drug manufacturer's discounts reach $4,850, you'll pay…_2022

Prescription Drug Coverage

Prescription Drug Deductible

$0
In-Network Prescription Drug Coverage - Initial Coverage

Tier 1 - Preferred Generics

Preferred Retail (31-day supply): $3 copay
Standard Retail (31-day supply): $13 copay
Preferred Retail (90-day supply): $9 copay
Standard Retail (90-day supply): $39 copay
Mail Order (90-day supply): $9 copay

Tier 2 - Generics

Preferred Retail (31-day supply): $10 copay
Standard Retail (31-day supply): $20 copay
Preferred Retail (90-day supply): $30 copay
Standard Retail (90-day supply): $60 copay
Mail Order (90-day supply): $30 copay

Tier 3 - Preferred Brands

Preferred Retail (31-day supply): $40 copay
Standard Retail (31-day supply): $47 copay
Preferred Retail (90-day supply): $120 copay
Standard Retail (90-day supply): $141 copay
Mail Order (90-day supply): $120 copay

Tier 4 - Non-Preferred Drugs

Preferred Retail (31-day supply): $93 copay
Standard Retail (31-day supply): $100 copay
Preferred Retail (90-day supply): $279 copay
Standard Retail (90-day supply): $300 copay
Mail Order (90-day supply): $279 copay

Tier 5 - Speciality Drugs

All Locations (31-day supply): 33% of the costs
Coverage in the coverage gap

This plan has coverage in the Part D coverage gap. Tier 1 (preferred generic drugs) and Tier 2 (generic drugs) medications are covered in the coverage gap. For these tiers, you continue to pay the same cost-sharing amounts as in the Initial Coverage Stage. You pay no more than $3 for Tier 1 medications at a preferred pharmacy. You pay no more than $10 for Tier 2 medications at a preferred pharmacy. You will pay no more than 25% of the costs for generics in all other tiers. For all brand drugs you pay no more than 25% of the costs.
Catastrophic Coverage

You pay the greater of $3.95 or 5% for generic drugs and drugs treated like generics. You pay the greater of $9.85 or 5% for brand name drugs.

Out of Network Coverage

Prescription Drugs Normally, we cover drugs filled at an out-of-network pharmacy only if you are not able to use one of our network pharmacies (for example, because you are traveling, need emergency or urgent care, or need a drug that it not available at an accessible network pharmacy). Chapter 3 of the Evidence of Coverage provides a full list of situations in which we may cover drugs from an out-of-network pharmacy. (See "Plan Documents" below.)

Plan Documents

  Summary of Benefits (PDF)
  Evidence of Coverage (PDF)
  Plan Rating (PDF)
  General Transition Notice (PDF)
  Low Income Subsidy Premium Summary Table for Those Receiving Extra Help (PDF)
  BlueMedicare RX (PDP) Comprehensive Formulary (PDF)
  Service Area Map
  Annual Notice of Change
  Enrollment Form
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