BlueMedicare Complete Rx (PDP) 2025

$0

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

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.

You pay the greater of $3.70 or 5% for generic drugs and drugs treated like generics. You pay the greater of $9.20 or 5% for brand name drugs.