Are you turning 65? Or are you on Medicare and losing coverage or moving?
See if you qualify for an enrollment period to sign up for a plan

Blue Cross MedicareRx Value (PDP)

Health Insurance Company: Blue Cross and Blue Shield of IL, NM, OK, TX

Medicare Prescription Drug Part D Plan Details

Blue Cross and Blue Shield of IL, NM, OK, TX
$99 /mo
monthly premium
Blue Cross MedicareRx Value (PDP)
Coverage
Overall Star Rating (2025)
  • Rx
3
out of 5 stars

General Plan Details

Prescription Drug Deductible
$590
Preferred Generic copay
$10
Preferred Brand copay
$44
Eligible for Low Income Subsidy
No

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

$8.00 copay (30-day supply)
$24.00 copay (90-day supply)

Tier 3: Preferred Brand

$42.00 copay (30-day supply)
$126.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

44% coinsurance (30-day supply)
44% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$10.00 copay (30-day supply)
$30.00 copay (90-day supply)

Tier 2: Generic

$20.00 copay (30-day supply)
$60.00 copay (90-day supply)

Tier 3: Preferred Brand

$44.00 copay (30-day supply)
$132.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

50% coinsurance (30-day supply)
50% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Rx Drug Coverage - Standard Mail Order Cost

Tier 1: Preferred Generic

$10.00 copay (30-day supply)
$30.00 copay (90-day supply)

Tier 2: Generic

$20.00 copay (30-day supply)
$60.00 copay (90-day supply)

Tier 3: Preferred Brand

$44.00 copay (30-day supply)
$132.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

50% coinsurance (30-day supply)
50% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Rx Drug Coverage - Preferred Mail Order Cost

Tier 1: Preferred Generic

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

Tier 2: Generic

$8.00 copay (30-day supply)
$24.00 copay (90-day supply)

Tier 3: Preferred Brand

$42.00 copay (30-day supply)
$126.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

44% coinsurance (30-day supply)
44% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Plan Links

Ready to Enroll Online?

Or call and get free advice from licensed insurance agents

TTY 711
Mon-Fri: 8am-9pm, Sat: 8am-8pm ET

Looking for other plans in your area?

Where This Plan is Available

Additional Plan Info

Plan Year:
2025

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following insurance companies:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • Anthem Blue Cross
  • Anthem Blue Cross and Blue Shield
  • Aspire Health Plan
  • Baylor Scott & White Health Plan
  • Capital Blue Cross
  • Cigna Healthcare
  • Dean Health Plan
  • Devoted Health
  • Florida Blue Medicare
  • Freedom Health
  • GlobalHealth
  • Health Care Service Corporation
  • Healthy Blue
  • HealthSun
  • Humana
  • Molina Healthcare
  • Mutual of Omaha
  • Medica Central Health Plan
  • Optimum HealthCare
  • Premera Blue Cross
  • SCAN Health Plan
  • Simply
  • UnitedHealthcareⓇ
  • Wellcare
  • WellPoint