2010 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | Blue MedicareRx Value (PDP) by Anthem Blue Cross and Blue Shield | ||||
State: | Missouri | ||||
Plan ID: | S5596 - 043 - 0 Click to see other plans | ||||
Member Services: | 1-866-755-2776 TTY users 1-866-798-7026 | ||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
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Email a copy of the Blue MedicareRx Value (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $42.20 | ||||
Annual Deductible: | $150 | ||||
$0 Premium if Full LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. | ||||
Annual Initial Coverage Limit (ICL): | $2,830 | ||||
Gap Coverage? | No Gap Coverage | ||||
Total Number of Formulary Drugs: | 3,251 drugs | Browse the Blue MedicareRx Value (PDP) Formulary | |||
This plan has 4 drug tiers. See cost-sharing highlights below. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $7.80 | $45.00 | 29% | 29% | |
• Number of Drugs per Tier: | 1650 | 629 | 608 | 364 | |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | National Plan | ||||
Number of Members enrolled in this plan in Missouri: | 5,943 members (CMS Region 18) | ||||
Number of Members enrolled in this plan nationally: | 282,774 members |