Blue MedicareRx (PDP)

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Your choice for drug coverage

Prescription drugs can be expensive. Blue MedicareRx is a Part D Prescription Drug Plan designed to help you manage your drug costs. Even if you don’t have drug costs now, this plan can protect you from the expense of prescription drugs you may need in the future.

Blue MedicareRx offers you:

Choose from three plan options

We offer three plan options — Essential, Value and Enhanced. Each option includes catastrophic coverage that helps protect against high drug costs after you have spent a certain amount on prescription drugs.

See below to compare our three options at each coverage stage.

Blue MedicareRx Essential (PDP)

Blue MedicareRx Value (PDP)

Blue MedicareRx Enhanced (PDP)

Monthly Plan premiumamount you pay

$28.50

$32.90

$96.60

Annual deductibleamount you pay before initial coverage begins

$0 on Tier 1 and Tier 2 drugs; $415 on Tier 3, Tier 4 and Tier 5 drugs

$415

$0

Initial coverage – amount you pay for a 30-day supply

 

   Tier 1 (Preferred Generic):

$0 copay for preferred retail cost sharing

$10 copay for standard retail cost sharing

$3 copay for preferred retail cost sharing

$6 copay for standard retail cost sharing

$0 copay for preferred retail cost sharing

$15 copay for standard retail cost sharing

   Tier 2 (Generic):

$1 copay for preferred retail cost sharing

$15 copay for standard retail cost sharing

$6 copay for preferred retail cost sharing

$12 copay for standard retail cost sharing

$4 copay for preferred retail cost sharing

$20 copay for standard retail cost sharing

  Tier 3 (Preferred Brand):

15% coinsurance for preferred retail cost sharing

24% coinsurance for standard retail cost sharing

16% coinsurance for preferred retail cost sharing

21% coinsurance for standard retail cost sharing

18% coinsurance for preferred retail cost sharing

25% coinsurance for standard retail cost sharing

   Tier 4 (Non-Preferred drug):

35% coinsurance for preferred retail cost sharing

48% coinsurance for standard retail cost sharing

33% coinsurance for preferred retail cost sharing

40% coinsurance for standard retail cost sharing

40% coinsurance for preferred retail cost sharing

50% coinsurance for standard retail cost sharing

   Tier 5 (Specialty):

25% coinsurance

25% coinsurance

33% coinsurance

Coverage gapamount you pay for a 30-day supply after your total yearly covered prescription drug costs reach $3,8201

Generic drugs

37% coinsurance

37% coinsurance

37% coinsurance

Brand-name drugs

No more than 25% coinsurance

No more than 25% coinsurance

No more than 25% coinsurance

Catastrophic coverageamount you pay for a 30-day supply after you have paid $5,100 in out-of-pocket prescription drug costs2

The greater of $3.40 copay for generic drugs and $8.50 copay for all other covered drugs or 5% coinsurance

Pharmacies in the preferred network (nationwide)

9,800

26,000

26,000

Mail Order (90-day supply)

3x 30-day supply cost or the usual coinsurance

3x 30-day supply cost or the usual coinsurance

2.5x 30-day supply cost or the usual coinsurance

1Your “total drug costs” means the total amount you have paid for covered drugs plus what the plan has paid for the calendar year. This does not include the plan premium you pay.

2Your “out-of-pocket costs” means the amount you have paid for covered drugs for the calendar year. This does not include the amount the plan has paid or the plan premium you pay.

Rates and coverage details

For plan rates and what's covered in each option, refer to the:

Order printed materials online at no cost to you

Place your order for printed materials, including enrollment kits for these and other BCBSAZ plans. Orders are mailed free of charge.

Use our pharmacy network for the greatest benefits

Once enrolled in Blue MedicareRx, you’ll have access to a nationwide network of pharmacies that include major chains as well as neighborhood pharmacies. You may go to any of our network pharmacies. However, your costs may be even less for your covered drugs if you use a network pharmacy that offers preferred cost sharing rather than a network that offers standard cost sharing.

In most cases, your prescriptions are covered only if they are filled at one of our network pharmacies. If you go to a pharmacy that is not in our network, you may have to pay more for your prescriptions and you may have to file a claim to be reimbursed. You will pay any difference between the non-network pharmacy’s charge and the amount the plan allows. Some drugs may have quantity limits or be subject to step therapy or prior authorization requirements.

Letters and phone calls once you join our plan

When you join the Blue MedicareRx plan you may receive an occasional phone call from the plan. For example, if you have other prescription drug coverage, you may receive a call asking that you verify your other coverage so that Medicare can coordinate your benefits with your other plan coverage.

You will receive a letter from the plan shortly after your enrollment application is received if an agent helped with your enrollment. Its purpose is to make sure you are enrolled in the correct plan, describe how the plan works and answer any questions you may have.

If you have any questions about a phone call you receive from the plan, please call 1-877-853-7693 (TTY hearing impaired users call 711), 8 a.m. to 8 p.m., daily, local time.

Medication Therapy Management (MTM) Program

If you meet certain requirements, you may be invited to participate in a program designed for your specific health and pharmacy needs. You may choose not to participate, but it is recommended that you take full advantage of this service if you are selected. Find out more about the program including who is eligible for MTM.