BlueMedicare Premier Rx (PDP)
Health Insurance Company: Florida Blue
Medicare Prescription Drug Part D Plan Details
General Plan Details
Prescription Drug Deductible
$545
Preferred Generic copay
$6
Preferred Brand copay
$47
Eligible for Low Income Subsidy
No
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
$16.00 copay (30-day supply)
$48.00 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
25% 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
$16.00 copay (30-day supply)
$48.00 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
25% coinsurance (30-day supply)
Plan Links
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Where This Plan is Available
State:
Counties:
Alachua, Baker, Bay, Bradford, Brevard, Broward, Calhoun, Charlotte, Citrus, Clay, Collier, Columbia, Desoto, Dixie, Duval, Escambia, Flagler, Franklin, Gadsden, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Indian River, Jackson, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Martin, Miami-Dade, Monroe, Nassau, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Saint Johns, Saint Lucie, Santa Rosa, Sarasota, Seminole, Sumter, Suwannee, Taylor, Union, Volusia, Wakulla, Walton, Washington
View all plans in your Florida County
Additional Plan Info
Year:
2024
Plan ID:
S5904-001-0
Insurance Company Website:
Florida Blue