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Compare Florida Blue Medicare Prescription Drug Plans

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Florida Blue Medicare Prescription Drug

BlueMedicare Premier Rx (PDP)

See Plan Details

$
per month

Prescription Drug Coverage

Prescription Drug Deductible

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

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

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.

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

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

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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