Initial Coverage:
tooltip_Until yearly drug costs reach $3,310, you'll pay..._2024
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..._2024
Catastrophic Coverage
tooltip_After your out-of-pocket costs plus the amount of the drug manufacturer's discounts reach $4,850, you'll pay…_2024
Prescription Drug Coverage
| Prescription Drug Deductible | $545 (applies to Tiers 3, 4, 5) |
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In-Network Prescription Drug Coverage - Initial Coverage During the Initial Coverage Stage, the plan pays its share of the cost of your drugs and you pay your share of the cost based on the Tier of the drug. You stay in this stage until your total drug costs (both your payments plus any plan payments) reach the Initial Coverage Limit (ICL). Once your reach the ICL, you move into the Coverage Gap Stage. |
Tier 1 - Preferred Generics
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| Coverage in the coverage gap | 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. |
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Catastrophic Coverage Once you reach the Catastrophic Stage, you pay a small copay and the plan will pay most of the cost of your drugs for the rest of the year. |
$0 copay |
Out of Network Coverage
| Prescription Drugs | This plan does not cover drugs filled at an out-of-network pharmacy. |
Plan Documents
| Summary of Benefits (PDF) |
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| Evidence of Coverage (PDF) |
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| Plan Rating (PDF) |
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| General Transition Notice (PDF) |
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| Low Income Subsidy Premium Summary Table for Those Receiving Extra Help (PDF) |
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| BlueMedicare RX (PDP) Comprehensive Formulary (PDF) |
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| Annual Notice of Change |
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| Enrollment Form |
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Why Choose Blue
Member Account
A secure members-only website that keeps you in control of your health and wellness with a variety of easy-to-use tools.
Health Club Discounts
Special Blue365 member discounted enrollment and membership at fitness centers across the state.
Care Coordination Team
A dedicated consultant to assist with coordinating appointments, in or outpatient stays, management of chronic conditions and help with finding the best price on procedures and prescriptions.
Florida Blue Retail Centers
Enjoy face-to-face customer service, wellness events and educational seminars at one of our unique retail centers.
