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Anthem Blue Cross MediBlue Rx Standard (PDP)

Health Insurance Company: Anthem / Anthem or Blue KC in Missouri

Medicare Prescription Drug Part D Plan Details

$136 /mo

monthly premium

Anthem Blue Cross MediBlue Rx Standard (PDP)

Coverage

Overall Star Rating (2025)

3.5

out of 5 stars

General Plan Details

Prescription Drug Deductible

$590

Preferred Generic copay

Preferred Brand copay

Eligible for Low Income Subsidy

Rx Drug Coverage - Preferred Retail Cost

Tier 1: Preferred Generic

$1.00 copay (30-day supply)
$3.00 copay (90-day supply)

Tier 2: Generic

$4.00 copay (30-day supply)
$12.00 copay (90-day supply)

Tier 3: Preferred Brand

17% coinsurance (30-day supply)
17% coinsurance (90-day supply)

Tier 4: Non-Preferred Drug

39% coinsurance (30-day supply)
39% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$4.00 copay (30-day supply)
$12.00 copay (90-day supply)

Tier 2: Generic

$7.00 copay (30-day supply)
$21.00 copay (90-day supply)

Tier 3: Preferred Brand

17% coinsurance (30-day supply)
17% coinsurance (90-day supply)

Tier 4: Non-Preferred Drug

39% coinsurance (30-day supply)
39% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Rx Drug Coverage - Standard Mail Order Cost

Tier 1: Preferred Generic

$1.00 copay (30-day supply)
$3.00 copay (90-day supply)

Tier 2: Generic

$4.00 copay (30-day supply)
$12.00 copay (90-day supply)

Tier 3: Preferred Brand

17% coinsurance (30-day supply)
17% coinsurance (90-day supply)

Tier 4: Non-Preferred Drug

39% coinsurance (30-day supply)
39% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Plan Links

Plan Link

Doctor Lookup

Drug Link

Ready to Enroll Online?

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(888) 311-4264

TTY 711

Mon-Fri: 8am-9pm, Sat: 8am-8pm ET

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Where This Plan is Available

State:

California

Counties:

Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Fresno, Glenn, Humboldt, Imperial, Inyo, Kern, Kings, Lake, Lassen, Los Angeles, Madera, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Orange, Placer, Plumas, Riverside, Sacramento, San Benito, San Bernardino, San Diego, San Francisco, San Joaquin, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tulare, Tuolumne, Ventura, Yolo, Yuba

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Additional Plan Info

Plan Year:

2025

Insurance Company Website:

Anthem / Anthem or Blue KC in Missouri

Anthem Blue Cross MediBlue Rx Standard (PDP)

Medicare Prescription Drug Part D Plan Details

General Plan Details

Rx Drug Coverage - Preferred Retail Cost

Tier 1: Preferred Generic

Tier 2: Generic

Tier 3: Preferred Brand

Tier 4: Non-Preferred Drug

Tier 5: Specialty Tier

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

Tier 2: Generic

Tier 3: Preferred Brand

Tier 4: Non-Preferred Drug

Tier 5: Specialty Tier

Rx Drug Coverage - Standard Mail Order Cost

Tier 1: Preferred Generic

Tier 2: Generic

Tier 3: Preferred Brand

Tier 4: Non-Preferred Drug

Tier 5: Specialty Tier

Plan Links

Where This Plan is Available

Additional Plan Info

Health Insurance Companies Offering Plans