Blue MedicareRx Value Plus (PDP)
Contract S2893, plan 001, segment 0 · offered by ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT · CMS PDP Region 02 (Vermont).
Plan features
| Monthly premium | $20.70 |
|---|---|
| Annual deductible | $615.00Tier 1 exempt |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,220 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in Vermont | 15,290 |
| Members nationally | 163,152 |
| Member services | (888)543-4917TTY 711 |
| Pharmacy search | www.rxmedicareplans.com |
| BIN / PCN | 004336 / MEDDADVSee BIN/PCNs for all plans |
CMS star ratings
- Part D summary rating
- 4 out of 5 stars for Part D summary rating
Published per contract, which is how CMS scores them — every plan under contract S2893 shares this rating.
Formulary tiers — preferred pharmacy, initial coverage phase
| Tier | Cost-sharing | Drugs on tier |
|---|---|---|
| Tier 1 | $0.00 | 187 |
| Tier 2 | $3.00 | 479 |
| Tier 3 | 17% | 1,051 |
| Tier 4 | 32% | 791 |
| Tier 5 | 25% | 712 |
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 | $5.00 | $0.00 | $0.00 | $15.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $5.00 | $0.00 | $0.00 | $15.00 | $0.00 |
| Tier 2: Generic | $3.00 | $11.00 | $3.00 | $9.00 | $33.00 | $6.00 |
| Tier 3: Preferred Brand | 17% | 25% | 17% | 17% | 25% | 17% |
| Tier 4: Non-Preferred Drug | 32% | 46% | 32% | 32% | 46% | 32% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | 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.