Horizon Medicare Blue Rx Enhanced (PDP)
Contract S5993, plan 003, segment 0 · offered by HORIZON INSURANCE COMPANY · CMS PDP Region 04 (New Jersey).
Plan features
| Monthly premium | $139.10 |
|---|---|
| Annual deductible | $200.00Tier 1 and 2 exempt |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,464 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in New Jersey | 15,157 |
| Members nationally | 15,208 |
| Member services | (800)391-1906TTY 711 |
| Pharmacy search | www.horizonblue.com/pdp-pharmacy-search |
| BIN / PCN | 016499 / PDPNJSee 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 S5993 shares this rating.
Formulary tiers — preferred pharmacy, initial coverage phase
| Tier | Cost-sharing | Drugs on tier |
|---|---|---|
| Tier 1 | $0.00 | 312 |
| Tier 2 | $6.00 | 625 |
| Tier 3 | 20% | 717 |
| Tier 4 | 45% | 1,047 |
| Tier 5 | 30% | 763 |
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 | $6.00 | $6.00 | $3.00 | $18.00 | $18.00 | $9.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $6.00 | $6.00 | $3.00 | $18.00 | $18.00 | $9.00 |
| Tier 3: Preferred Brand | 20% | 20% | 20% | 20% | 20% | 20% |
| Tier 4: Non-Preferred Drug | 45% | 45% | 45% | 45% | 45% | 45% |
| Tier 5: Specialty Tier | 30% | 30% | n/a | 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.