MedicarePartD.guide

A non-government resource built from CMS public data

BlueCross Rx Value (PDP)

Contract S5953, plan 001, segment 0 · offered by BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA · CMS PDP Region 09 (South Carolina).

Plan features

Monthly premium$139.70
Annual deductible$615.00Tier 1 and 6 exempt
Drug benefit type—
$0 premium with full LIS—
Premium with Extra Help (LIS)—
Formulary drugs3,151
Formulary exception tier—
Mail order offered—
Plan reach—
Members in South Carolina—
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$12.00—
Tier 2$17.00—
Tier 317%—
Tier 450%—
Tier 525%—
Tier 6$5.00—

Cost-sharing by coverage phase

Tier30-day supply90-day supply
PreferredStandardMail OrderPreferredStandardMail Order
Initial deductible phase
Tier 1: Preferred Generic$12.00$15.00$12.00$36.00$45.00$30.00
Tier 6: Select Care Drugs$5.00$8.00$5.00$15.00$24.00$12.50
Initial coverage phase
Tier 1: Preferred Generic$12.00$15.00$12.00$36.00$45.00$30.00
Tier 2: Generic$17.00$20.00$17.00$51.00$60.00$42.50
Tier 3: Preferred Brand17%19%17%17%19%17%
Tier 4: Non-Preferred Drug50%50%50%50%50%50%
Tier 5: Specialty Tier25%25%25%n/an/an/a
Tier 6: Select Care Drugs$5.00$8.00$5.00$15.00$24.00$12.50
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
Tier 6: Select Care Drugs$0.00$0.00$0.00$0.00$0.00$0.00