2025 Medicare Prescription Drug Formulary (Drug List) Cost-Sharing Details | ||||||
Anthem MediBlue Rx Standard (PDP) (S5596-046-0) Benefits & Contact Info all covered insulin pay $35 or less | ||||||
This plan is available in CMS PDP Region 01 which includes: ME NH Click on a letter below to view the Anthem MediBlue Rx Standard (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 |
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Preferred Pharmacy | Standard Pharmacy | Mail- Order* | Preferred Pharmacy | Standard Pharmacy | Mail- Order* | |
Initial Deductible Phase Cost Sharing | ||||||
All Formulary Drug Tiers: | 100% | 100% | 100% | 100% | 100% | 100% |
Initial Coverage Phase Cost-Sharing | ||||||
Tier 1: Preferred Generic: | $1.00 | $4.00 | $1.00 | $3.00 | $12.00 | $3.00 |
Tier 2: Generic: | $4.00 | $7.00 | $4.00 | $12.00 | $21.00 | $12.00 |
Tier 3: Preferred Brand: | 17% | 17% | 17% | 17% | 17% | 17% |
Tier 4: Non-Preferred Drug: | 50% | 50% | 50% | 50% | 50% | 50% |
Tier 5: Specialty Tier: | 25% | 25% | 25% | n/a | n/a | n/a |
Catastrophic Coverage Phase Cost Sharing | ||||||
All Formulary Drugs: |
$0 cost-sharing. The Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing once your TrOOP reaches the established maximum cap on out-of-pocket spending for Part D formulary drugs (RxMOOP). | |||||
Go to the Anthem MediBlue Rx Standard (PDP) 2025 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 |