MedicareBlue Rx Standard (PDP)
Contract S5743, plan 001, segment 0 · offered by WELLMARK IA & SD, & BCBS MN, MT, NE, ND,& WY · CMS PDP Region 25 (Iowa) · see other plans.
- ✉ Email a copy of the plan benefit details
- Benefits in plain text
- Cost-sharing for all pharmacies and tiers
- Star rating details
- Formulary on the plan's website
- Browse the MedicareBlue Rx Standard (PDP) formulary (drug list)
- Look up a drug's cost in this plan
Renewed for 2026. CMS carries this plan forward from 2025 under the same id. See every 2025 → 2026 change.
Plan features
| Monthly premium | $101.00 |
|---|---|
| — basic (standard) part | $101.00? |
| — supplemental (enhanced) part | $0.00 |
| Annual deductible | $615.00 |
| Out-of-pocket threshold | $2,100.00 |
| Drug benefit type | Actuarially Equivalent Standard? |
| $0 premium with full LIS | No |
| Premium with Extra Help (LIS) | $59.50? |
| LIS benchmark status | Above the regional benchmark |
| Formulary drugs | 3,014 |
| Formulary exception tier | Tier 4? |
| Plan reach | Regional plan |
| Members in Iowa | 27,470 |
| Members nationally | 84,122 |
| Member services | (888)832-0075TTY 711 |
| Pharmacy search | www.YourMedicareSolutions.com |
| BIN / PCN | 610455 / CSPDP?See BIN/PCNs for all plans |
The plan’s own pages: Plan website · Formulary · Pharmacy directory
CMS star ratings
- Part D summary rating
- 3.5 out of 5 stars for Part D summary rating
- Customer service
- 3 out of 5 stars for Customer service
- Member experience
- 4 out of 5 stars for Member experience
- Drug pricing & patient safety
- 4 out of 5 stars for Drug pricing & patient safety
Published per contract, which is how CMS scores them — every plan under contract S5743 shares this rating. How the ratings work
Formulary tiers — preferred pharmacy, initial coverage phase
| Tier | Cost-sharing | Drugs on tier |
|---|---|---|
| Tier 1 · Preferred Generic | $0.00 | 203 |
| Tier 2 · Generic | $1.00 | 454 |
| Tier 3 · Preferred Brand | 22% | 644 |
| Tier 4 · Non-Preferred Drug | 42% | 1,023 |
| Tier 5 · Specialty Tier | 25% | 690 |
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 | $0.00 | $5.00 | $0.00 | $0.00 | $15.00 | $0.00 |
| Tier 2: Generic | $1.00 | $7.00 | $1.00 | $3.00 | $21.00 | $3.00 |
| Tier 3: Preferred Brand | 22% | 25% | 22% | 22% | 25% | 22% |
| Tier 4: Non-Preferred Drug | 42% | 50% | 42% | 42% | 50% | 42% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 2: Generic | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 3: Preferred Brand | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 4: Non-Preferred Drug | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 5: Specialty Tier | 0% | 0% | 0% | 0% | 0% | 0% |
Benefits in plain text
MedicareBlue Rx Standard (PDP) (S5743-001-0) is a 2026 Medicare Part D prescription drug plan offered by WELLMARK IA & SD, & BCBS MN, MT, NE, ND,& WY in Iowa (CMS PDP Region 25).
The plan has a monthly premium of $101.00 and an annual drug deductible of $615.00.
Its drug benefit type is Actuarially Equivalent Standard.
With full Extra Help (the Low-Income Subsidy), the monthly premium is $59.50.
The plan's formulary lists 3,014 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): $1.00; tier 3 (Preferred Brand): 22%; tier 4 (Non-Preferred Drug): 42%; tier 5 (Specialty Tier): 25%.
CMS gives the plan's contract (S5743) a Part D summary rating of 3.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files.