BlueMedicare Premier Rx (PDP) 2024

$480 (applies to Tiers 3, 4, 5)

Tier 1 - Preferred Generics

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

Tier 2 - Generics

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

Tier 3 - Preferred Brands

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

Tier 4 - Non-Preferred Drugs

All Locations (31-day supply): 50% of the costs
All Locations (90-day supply): 50% of the costs

Tier 5 - Speciality Drugs

All Locations (31-day supply): 25% of the costs

You pay no more than 25% of the costs for preferred generic, generic and generic specialty drugs. You pay no more than 25% of the costs for brand name drugs and non-generic specialty drugs in the coverage gap.

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.