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 drugs | 3,461 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in North Carolina | 23,365 |
| Members nationally | 23,460 |
| Member services | (888)247-4142TTY 711 |
| Pharmacy search | medicare.bluecrossnc.com/prescription-drug-coverage |
| BIN / PCN | 015905 / PDPNCSee BIN/PCNs for all plans |
CMS star ratings
- Part D summary rating
- 3 out of 5 stars for Part D summary rating
Published per contract, which is how CMS scores them — every plan under contract S5540 shares this rating.
Formulary tiers — preferred pharmacy, initial coverage phase
| Tier | Cost-sharing | Drugs on tier |
|---|---|---|
| Tier 1 | $3.00 | 309 |
| Tier 2 | $6.00 | 628 |
| Tier 3 | $45.00 | 714 |
| Tier 4 | 40% | 1,046 |
| Tier 5 | 33% | 764 |
Cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail 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 Drug | 40% | 40% | 40% | 40% | 40% | 40% |
| Tier 5: Specialty Tier | 33% | 33% | 33% | n/a | n/a | n/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 |
Plan facts come from the CMS quarterly prescription drug plan public use files.