BlueMedicare Premier Rx (PDP)
Contract S5904, plan 001, segment 0 · offered by BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. · CMS PDP Region 11 (Florida).
Plan features
| Monthly premium | $98.60 |
|---|---|
| Annual deductible | $615.00Tier 6 exempt |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,014 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in Florida | 40,995 |
| Members nationally | 41,185 |
| Member services | (800)926-6565TTY (800)955-8770 |
| Pharmacy search | FloridaBlue.com/medicare |
| BIN / PCN | 012833 / MedDPrimeSee BIN/PCNs for all plans |
CMS star ratings
- Part D summary rating
- 3.5 out of 5 stars for Part D summary rating
Published per contract, which is how CMS scores them — every plan under contract S5904 shares this rating.
Formulary tiers — preferred pharmacy, initial coverage phase
| Tier | Cost-sharing | Drugs on tier |
|---|---|---|
| Tier 1 | $3.00 | 78 |
| Tier 2 | $14.00 | 393 |
| Tier 3 | 20% | 632 |
| Tier 4 | 40% | 1,019 |
| Tier 5 | 25% | 690 |
| Tier 6 | $3.00 | 202 |
Cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 6: Select Care Drugs | $3.00 | $3.00 | $3.00 | $9.00 | $9.00 | $9.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $3.00 | $3.00 | $3.00 | $9.00 | $9.00 | $9.00 |
| Tier 2: Generic | $14.00 | $14.00 | $14.00 | $42.00 | $42.00 | $42.00 |
| Tier 3: Preferred Brand | 20% | 20% | 20% | 20% | 20% | 20% |
| Tier 4: Non-Preferred Drug | 40% | 40% | 40% | 40% | 40% | 40% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $3.00 | $3.00 | $3.00 | $9.00 | $9.00 | $9.00 |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Plan facts come from the CMS quarterly prescription drug plan public use files.