MedicarePartD.guide

A non-government resource built from CMS public data

Blue Medicare Rx Enhanced (PDP)

Contract S5540, plan 004, segment 0 · offered by BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA · CMS PDP Region 08 (North Carolina).

Plan features

Monthly premium$163.20
Annual deductible$0.00
Drug benefit type—
$0 premium with full LIS—
Premium with Extra Help (LIS)—
Formulary drugs3,461
Formulary exception tier—
Mail order offered—
Plan reach—
Members in North Carolina—
Members nationally—
Member services—
BIN / PCN—

CMS star ratings

Summary rating
3 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$6.00—
Tier 3$45.00—
Tier 440%—
Tier 533%—

Cost-sharing by coverage phase

Tier30-day supply90-day supply
PreferredStandardMail OrderPreferredStandardMail Order
Initial coverage phase
Tier 1: Preferred Generic$3.00$15.00$3.00$9.00$45.00$9.00
Tier 2: Generic$6.00$20.00$6.00$18.00$60.00$18.00
Tier 3: Preferred Brand$45.00$47.00$45.00$135.00$141.00$135.00
Tier 4: Non-Preferred Drug40%40%40%40%40%40%
Tier 5: Specialty Tier33%33%33%n/an/an/a
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