BlueMedicare Complete Rx (PDP)
Contract S5904, plan 002, segment 0 · offered by BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. · CMS PDP Region 11 (Florida).
Plan features
| Monthly premium | $217.00 |
|---|---|
| Annual deductible | $615.00Tier 1, 2 and 6 exempt |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,251 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in Florida | at least 5,48422 counties suppressed by CMS (under 11 enrollees) |
| Members nationally | 5,635 |
| 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 | $0.00 | 107 |
| Tier 2 | $3.00 | 549 |
| Tier 3 | 18% | 419 |
| Tier 4 | 29% | 1,228 |
| Tier 5 | 25% | 720 |
| Tier 6 | $0.00 | 228 |
Cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $3.00 | $3.00 | $3.00 | $9.00 | $9.00 | $9.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $3.00 | $3.00 | $3.00 | $9.00 | $9.00 | $9.00 |
| Tier 3: Preferred Brand | 18% | 18% | 18% | 18% | 18% | 18% |
| Tier 4: Non-Preferred Drug | 29% | 29% | 29% | 29% | 29% | 29% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| 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.