Blue Shield Rx Enhanced (PDP)
Health Insurance Company: Blue Shield of California
Medicare Prescription Drug Part D Plan Details
- Rx
General Plan Details
Rx Drug Coverage - Preferred Retail Cost
Tier 1: Preferred Generic
$2.00 copay (30-day supply)
$4.00 copay (90-day supply)
Tier 2: Generic
$7.00 copay (30-day supply)
$14.00 copay (90-day supply)
Tier 3: Preferred Brand
$43.00 copay (30-day supply)
$129.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
47% coinsurance (30-day supply)
47% coinsurance (90-day supply)
Tier 5: Specialty Tier
33% coinsurance (30-day supply)
Rx Drug Coverage - Standard Retail Cost
Tier 1: Preferred Generic
$11.00 copay (30-day supply)
$33.00 copay (90-day supply)
Tier 2: Generic
$14.00 copay (30-day supply)
$42.00 copay (90-day supply)
Tier 3: Preferred Brand
$47.00 copay (30-day supply)
$141.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
50% coinsurance (30-day supply)
50% coinsurance (90-day supply)
Tier 5: Specialty Tier
33% coinsurance (30-day supply)
Rx Drug Coverage - Standard Mail Order Cost
Tier 1: Preferred Generic
$4.00 copay (90-day supply)
Tier 2: Generic
$14.00 copay (90-day supply)
Tier 3: Preferred Brand
$86.00 copay (90-day supply)
Tier 4: Non-Preferred Drug
47% coinsurance (90-day supply)
Tier 5: Specialty Tier
33% coinsurance (30-day supply)
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