Blue MedicareRx Premier (PDP)
Contract S2893, plan 003, segment 0 · offered by ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT · CMS PDP Region 02 (Vermont).
Plan features
| Monthly premium | $238.60 |
|---|---|
| Annual deductible | $0.00 |
| Drug benefit type | — |
| $0 premium with full LIS | — |
| Premium with Extra Help (LIS) | — |
| Formulary drugs | 3,349 |
| Formulary exception tier | — |
| Plan reach | — |
| Members in Vermont | at least 6743 counties suppressed by CMS (under 11 enrollees) |
| Members nationally | 13,486 |
| 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 | $1.00 | 395 |
| Tier 2 | $7.00 | 491 |
| Tier 3 | $30.00 | 905 |
| Tier 4 | 35% | 727 |
| Tier 5 | 33% | 831 |
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 | $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 Drug | 35% | 44% | 35% | 35% | 44% | 35% |
| 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.