BlueRx Enhanced Plus (PDP)
Health Insurance Company: BlueRx (PDP)
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
$10.00 copay (30-day supply)
$20.00 copay (90-day supply)
Tier 3: Preferred Brand
$40.00 copay (30-day supply)
$80.00 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)
33% coinsurance (90-day supply)
Rx Drug Coverage - Standard Retail Cost
Tier 1: Preferred Generic
$9.00 copay (30-day supply)
$27.00 copay (90-day supply)
Tier 2: Generic
$17.00 copay (30-day supply)
$51.00 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)
33% coinsurance (90-day supply)
Rx Drug Coverage - Standard Mail Order Cost
Tier 1: Preferred Generic
$9.00 copay (30-day supply)
$18.00 copay (90-day supply)
Tier 2: Generic
$17.00 copay (30-day supply)
$34.00 copay (90-day supply)
Tier 3: Preferred Brand
$47.00 copay (30-day supply)
$94.00 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)
33% coinsurance (90-day supply)
Rx Drug Coverage - Preferred Mail Order Cost
Tier 1: Preferred Generic
$2.00 copay (30-day supply)
$4.00 copay (90-day supply)
Tier 2: Generic
$10.00 copay (30-day supply)
$20.00 copay (90-day supply)
Tier 3: Preferred Brand
$40.00 copay (30-day supply)
$80.00 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)
33% coinsurance (90-day supply)
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