On Medicare? Annual Open Enrollment Is Now

Oct 15th - Dec 7th

Enroll for 2025 coverage

Prescription Blue Premium (PDP)

Health Insurance Company: Blue Cross Blue Shield of Michigan

Medicare Prescription Drug Part D Plan Details

$139 /mo

monthly premium

Prescription Blue Premium (PDP)

Coverage

Overall Star Rating (2025)

out of 5 stars

General Plan Details

Prescription Drug Deductible

Preferred Generic copay

Preferred Brand copay

$45

Eligible for Low Income Subsidy

Rx Drug Coverage - Preferred Retail Cost

Tier 1: Preferred Generic

$1.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$5.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 3: Preferred Brand

$40.00 copay (30-day supply)
$120.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

45% coinsurance (30-day supply)
45% coinsurance (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$6.00 copay (30-day supply)
$18.00 copay (90-day supply)

Tier 2: Generic

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

Tier 3: Preferred Brand

$45.00 copay (30-day supply)
$135.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

45% coinsurance (30-day supply)
45% coinsurance (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Rx Drug Coverage - Standard Mail Order Cost

Tier 1: Preferred Generic

$6.00 copay (30-day supply)
$18.00 copay (90-day supply)

Tier 2: Generic

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

Tier 3: Preferred Brand

$45.00 copay (30-day supply)
$135.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

45% coinsurance (30-day supply)
45% coinsurance (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Rx Drug Coverage - Preferred Mail Order Cost

Tier 1: Preferred Generic

$1.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$5.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 3: Preferred Brand

$40.00 copay (30-day supply)
$120.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

45% coinsurance (30-day supply)
45% coinsurance (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Plan Links

Plan Link

Doctor Lookup

Drug Link

Ready to Enroll Online?

Or call and get free advice from licensed insurance agents

(888) 311-4264

TTY 711

Mon-Fri: 8am-10pm, Sat-Sun: 8am-9pm ET

Looking for other plans in your area?

Where This Plan is Available

State:

Michigan

Counties:

Alcona, Alger, Allegan, Alpena, Antrim, Arenac, Baraga, Barry, Bay, Benzie, Berrien, Branch, Calhoun, Cass, Charlevoix, Cheboygan, Chippewa, Clare, Clinton, Crawford, Delta, Dickinson, Eaton, Emmet, Genesee, Gladwin, Gogebic, Grand Traverse, Gratiot, Hillsdale, Houghton, Huron, Ingham, Ionia, Iosco, Iron, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Keweenaw, Lake, Lapeer, Leelanau, Lenawee, Livingston, Luce, Mackinac, Macomb, Manistee, Marquette, Mason, Mecosta, Menominee, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Ontonagon, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Saint Clair, Saint Joseph, Sanilac, Schoolcraft, Shiawassee, Tuscola, Van Buren, Washtenaw, Wayne, Wexford

View all plans in your Michigan County

Additional Plan Info

Plan Year:

2025

Insurance Company Website:

Blue Cross Blue Shield of Michigan

Prescription Blue Premium (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

Rx Drug Coverage - Preferred 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