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Compare Florida Blue Medicare Prescription Drug Plans

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Florida Blue Medicare Prescription Drug

BlueMedicare Premier Rx (PDP)

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$
per month

Florida Blue Medicare Prescription Drug

BlueMedicare Complete Rx (PDP)

See Plan Details

$
per month

Prescription Drug Coverage

Prescription Drug Deductible

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

$0

In-Network Prescription Drug Coverage - Initial Coverage

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

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

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.

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.

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

This plan does not cover drugs filled at an out-of-network pharmacy.

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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