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2023 Medicare Prescription Drug Plan Cost-Sharing Details
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
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2023 Medicare Prescription Drug
Formulary (Drug List) Cost-Sharing Details
Blue Rx Plus (PDP) (S3375-002-0)
Benefit Details        
all covered insulin pay $35 or less
This plan is available in CMS PDP Region 3
Click on a letter below to view the
Blue Rx Plus (PDP) Formulary
A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  0-9 
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: $1.00 $19.00 $1.00 $3.00 $57.00 $3.00
Tier 2: Generic: $4.00 $20.00 $4.00 $12.00 $60.00 $12.00
Tier 3: Preferred Brand: $47.00 $47.00 $47.00 $141.00 $141.00 $141.00
Tier 4: Non-Preferred Drug: 50% 50% 50% 50% 50% 50%
Tier 5: Specialty Tier: 33% 33% 33% n/a n/a n/a
Coverage Gap (Donut Hole) Phase Cost Sharing
Plan offers no Gap Coverage -- 75% Generic and 75% Brand Donut Hole Discount applies
All Formulary Generic Drugs: 25% 25% 25% 25% 25% 25%
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 $4.15 The greater of 5% or $4.15
Other Drugs (Brand-Name or Non-Preferred Multi-Source Drugs): The greater of 5% or $10.35 The greater of 5% or $10.35
Go to the Blue Rx Plus (PDP) 2023 Formulary Browser by choosing a letter below:
A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  0-9 
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