MedicarePartD.guide

A non-government resource built from CMS public data

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 drugs3,014
Formulary exception tier—
Mail order offered—
Plan reach—
Members in Florida—
Members nationally—
Member services—
BIN / PCN—

CMS star ratings

Summary rating
3.5 out of 5 stars for Summary rating
Customer service
—
Member experience
—
Drug pricing & patient safety
—

Formulary tiers — preferred pharmacy, initial coverage phase

TierCost-sharingDrugs on tier
Tier 1$3.00—
Tier 2$14.00—
Tier 320%—
Tier 440%—
Tier 525%—
Tier 6$3.00—

Cost-sharing by coverage phase

Tier30-day supply90-day supply
PreferredStandardMail OrderPreferredStandardMail 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 Brand20%20%20%20%20%20%
Tier 4: Non-Preferred Drug40%40%40%40%40%40%
Tier 5: Specialty Tier25%25%25%n/an/an/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