MedicarePartD.guide

A non-government resource built from CMS public data

MedicareBlue Rx Standard (PDP)

Contract S5743, plan 001, segment 0 · offered by WELLMARK IA & SD, & BCBS MN, MT, NE, ND,& WY · CMS PDP Region 25 (Montana).

Plan features

Monthly premium$101.00
Annual deductible$615.00
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 Montana—
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$0.00—
Tier 2$1.00—
Tier 322%—
Tier 442%—
Tier 525%—

Cost-sharing by coverage phase

Tier30-day supply90-day supply
PreferredStandardMail OrderPreferredStandardMail Order
Initial coverage phase
Tier 1: Preferred Generic$0.00$5.00$0.00$0.00$15.00$0.00
Tier 2: Generic$1.00$7.00$1.00$3.00$21.00$3.00
Tier 3: Preferred Brand22%25%22%22%25%22%
Tier 4: Non-Preferred Drug42%50%42%42%50%42%
Tier 5: Specialty Tier25%25%25%n/an/an/a
Catastrophic coverage phase
Tier 1: Preferred Generic0%0%0%0%0%0%
Tier 2: Generic0%0%0%0%0%0%
Tier 3: Preferred Brand0%0%0%0%0%0%
Tier 4: Non-Preferred Drug0%0%0%0%0%0%
Tier 5: Specialty Tier0%0%0%0%0%0%