Blue MedicareRx Premier (PDP)

A $0 annual deductible plan that helps lower costs with preferred cost-sharing at participating network retail pharmacies and additional coverage in the gap

Annual Deductible: $0

Monthly Premium: $155.80

Annual Deductible $0
Monthly Premium $155.80
To better understand your cost, visit the Drug Pricing Tool and enter all of your current medications to see an estimate of your total cost, including monthly premium, deductible and copays.

Copayment & Coinsurance

The amount or percentage you pay each time you fill a prescription until your total drug costs for the year reach $5,030.
Tier level

Preferred Cost-Sharing Pharmacies

Amount for 30-day supply

Standard Cost-Sharing Pharmacies

Amount for 30-day supply

CVS Caremark Mail Service1

Amount for 90-day supply
Tier 1 $1.00 $6.00 $1.00
Tier 2 $7.00 $12.00 $14.00
Tier 3 $30.00 $40.00 $60.00
Tier 4 35% 44% 35%
Tier 5 33% 33% N/A2

Preferred Cost-Sharing Pharmacies

A Pharmacy where Blue MedicareRx members may get lower copays and coinsurance on covered drugs than standard cost-sharing pharmacies.

Tier 1

30-day supply: $1.00

Tier 2

30-day supply: $7.00

Tier 3

30-day supply: $30.00

Tier 4

30-day supply: 35%

Tier 5

30-day supply: 33%

Standard Cost-Sharing Pharmacies

A standard pharmacy is one that contracts with a Medicare Part D plan allowing members of the plan to fill prescriptions under their plan benefit, but may not offer lower copays and coinsurance offered by a preferred cost-sharing pharmacy.

Tier 1

30-day supply: $6.00

Tier 2

30-day supply: $12.00

Tier 3

30-day supply: $40.00

Tier 4

30-day supply: 44%

Tier 5

30-day supply: 33%

CVS Caremark Mail Service1

A pharmacy that fills and delivers prescriptions ordered by phone, mail or secure website that makes prescriptions available through mail order.

Tier 1

90-day supply: $1.00

Tier 2

90-day supply: $14.00

Tier 3

90-day supply: $60.00

Tier 4

90-day supply: 35%

Tier 5

90-day supply: N/A2

Both Preferred and Standard pharmacies in the Premier Pharmacy Network include Walmart and CVS / pharmacy as well as many community - based independent pharmacies, regional chain and grocery store pharmacies.
You can save over 70% on Tier 1 medications when you choose a preferred cost sharing pharmacy. Visit the Pharmacy Locator to find the closest Preferred Pharmacy to you.3

Coverage Gap

You reach the Coverage Gap when your total yearly drug costs reach $5,030 (not including monthly premiums).

Tier level

Preferred Cost-Sharing Pharmacies

Amount for 30-day supply

Standard Cost-Sharing Pharmacies

Amount for 30-day supply

CVS Caremark Mail Service1

Amount for 90-day supply
Tier 1 $1.00 $6.00 $1.00
Tier 2 $7.00 $12.00 $14.00
Tier 3,4 & 5
Generic Drugs		 25% 25% 25%
Brand Drugs 25% 25% 25%

Catastrophic Coverage

You reach the Catastrophic Coverage Stage when you have spent $8,000 out of pocket (not including monthly premiums).

Generic Drugs Not Applicable
All Other Drugs Not Applicable

Coverage Gap

You reach the Coverage Gap when your total yearly drug costs reach $5,030 (not including monthly premiums).

Preferred Cost-Sharing Pharmacies

Tier 1

30-day supply: $1.00

Tier 2

30-day supply: $7.00

Tier 3,4 & 5 Generic Drugs

30-day supply: 25%

Tier 3,4 & 5 Brand Drugs

30-day supply: 25%

Standard Cost-Sharing Pharmacies

Tier 1

30-day supply: $6.00

Tier 2

30-day supply: $12.00

Tier 3,4 & 5 Generic Drugs

30-day supply: 25%

Tier 3,4 & 5 Brand Drugs

30-day supply: 25%

CVS Caremark Mail Service1

Tier 1

90-day supply: $1.00

Tier 2

90-day supply: $14.00

Tier 3,4 & 5 Generic Drugs

90-day supply: 25%

Tier 3,4 & 5 Brand Drugs

90-day supply: 25%

Catastrophic Coverage

You reach the Catastrophic Coverage Stage when you have spent $8,000 out of pocket (not including monthly premiums).

Generic Drugs

Max of 5% or $4.50

All Other Drugs

Max of 5% or $11.20

For help making an informed decision about Blue MedicareRx Part D enrollment, view the Blue MedicareRx Document Library

1New Medicare regulations require all Part D plans to obtain patient consent before each delivery of new or refilled prescription. Shipments typically take 10 business days to deliver after the pharmacy receives an order. If your mail order drugs do not arrive within the estimated time frames please contact us.

2 Tier 5 CVS Caremark Mail Service is available at a 30-day supply only.

3Percent savings based on Blue MedicareRx preferred vs. standard pharmacy copays for a 30-day supply of Tier 1 medications. Savings may vary by drug tier and coverage stage.