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TTY: 711TTY: 711
24 hours a day, 7 days a week
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: $126.60
Preferred Cost-Sharing Pharmacies
Standard Cost-Sharing Pharmacies
CVS Caremark Mail Service1
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%
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.
30-day supply: $6.00
30-day supply: $12.00
30-day supply: $40.00
30-day supply: 44%
A pharmacy that fills and delivers prescriptions ordered by phone, mail or secure website that makes prescriptions available through mail order.
90-day supply: $1.00
90-day supply: $14.00
90-day supply: $60.00
90-day supply: 35%
90-day supply: N/A2
Coverage Gap
You reach the Coverage Gap when your total yearly drug costs reach $4,660 (not including monthly premiums).
Catastrophic Coverage
You reach the Catastrophic Coverage Stage when you have spent $7,400 out of pocket (not including monthly premiums).
Tier 3,4 & 5 Generic Drugs
30-day supply: 25%
Tier 3,4 & 5 Brand Drugs
90-day supply: 25%
Generic Drugs
Max of 5% or $4.15
All Other Drugs
Max of 5% or $10.35
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.