2019 Medicare Prescription Drug Plan Cost-Sharing Details

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2019 Medicare Part D Prescription Drug
Formulary (Drug List) Cost-Sharing Details
BlueRx Enhanced Plus (PDP) (S1030-001-0)
Benefit Details        
This plan is available in CMS PDP Region 12
which includes: AL TN

Monthly Premium: $119.90
Rx Deductible: $0
Initial Coverage Limit: $3,820 Qualifies for LIS: No


Click on a letter below to view the
BlueRx Enhanced Plus (PDP) Formulary
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This Plan Uses Lower Cost-Sharing for Preferred Pharmacies
  30-Day Supply
Cost-Sharing
90-Day Supply
Cost-Sharing
Preferred Pharmacy Standard Pharmacy Mail- Order* Preferred Pharmacy Standard Pharmacy Mail- Order*
This plan does not have an Initial Deductible:n/an/an/an/an/an/a
Initial Coverage Phase Cost-Sharing
Tier 1: Preferred Generic: $2.00 $9.00 $2.00 $4.00 $27.00 $4.00
Tier 2: Generic: $8.00 $15.00 $8.00 $16.00 $45.00 $16.00
Tier 3: Preferred Brand: $40.00 $47.00 $40.00 $80.00 $141.00 $80.00
Tier 4: Non-Preferred Brand: 45% 50% 45% 45% 50% 45%
Tier 5: Specialty Tier: 33% 33% 33% 33% 33% 33%
Coverage Gap (Donut Hole) Phase Cost Sharing
Plan offers no Gap Coverage 63% Generic and 75% Brand Donut Hole Discount applies
All Formulary Generic Drugs: 37% 37% 37% 37% 37% 37%
All Formulary Brand-Name Drugs: 25% 25% 25% 25% 25% 25%
Catastrophic Coverage Phase Cost Sharing
Generic & Preferred Multi-Source Drugs: The greater of 5% or $3.40 The greater of 5% or $3.40
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $8.50 The greater of 5% or $8.50
Go to the BlueRx Enhanced Plus (PDP) 2019 Formulary Browser by choosing a letter below:
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