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Anthem MediBlue Rx Standard (PDP)

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

Medicare Prescription Drug Part D Plan Details

$102 /mo

monthly premium

Anthem 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

49% coinsurance (30-day supply)
49% 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

49% coinsurance (30-day supply)
49% 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

49% coinsurance (30-day supply)
49% 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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Mon-Fri: 8am-9pm, Sat: 8am-8pm ET

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Where This Plan is Available

State:

Ohio

Counties:

Adams, Allen, Ashland, Ashtabula, Athens, Auglaize, Belmont, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Hancock, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Huron, Jackson, Jefferson, Knox, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Marion, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan, Morrow, Muskingum, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Richland, Ross, Sandusky, Scioto, Seneca, Shelby, Stark, Summit, Trumbull, Tuscarawas, Union, Van Wert, Vinton, Warren, Washington, Wayne, Williams, Wood, Wyandot

View all plans in your Ohio County

Additional Plan Info

Plan Year:

2025

Insurance Company Website:

Anthem / Anthem or Blue KC in Missouri

Anthem 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