MedicarePartD.guide

A non-government resource built from CMS public data

Blue MedicareRx Premier (PDP)

Contract S2893, plan 003, segment 0 · offered by ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT · CMS PDP Region 02 (Rhode Island).

Plan features

Monthly premium$238.60
Annual deductible$0.00
Drug benefit type—
$0 premium with full LIS—
Premium with Extra Help (LIS)—
Formulary drugs3,349
Formulary exception tier—
Mail order offered—
Plan reach—
Members in Rhode Island—
Members nationally—
Member services—
BIN / PCN—

CMS star ratings

Summary rating
4 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$1.00—
Tier 2$7.00—
Tier 3$30.00—
Tier 435%—
Tier 533%—

Cost-sharing by coverage phase

Tier30-day supply90-day supply
PreferredStandardMail OrderPreferredStandardMail Order
Initial coverage phase
Tier 1: Preferred Generic$1.00$6.00$1.00$3.00$18.00$1.00
Tier 2: Generic$7.00$12.00$7.00$21.00$36.00$14.00
Tier 3: Preferred Brand$30.00$40.00$30.00$90.00$120.00$60.00
Tier 4: Non-Preferred Drug35%44%35%35%44%35%
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