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Stand-alone Prescription Drug Plans can help reduce your costs for medications
Medicare Part D Prescription Drug Plans (PDP) help people with Medicare afford prescription drugs since Original Medicare doesn’t cover medications. If you have Original Medicare, you may want a PDP to get coverage for your drugs. Medicare Part D plans are sold by private insurance companies, like Florida Blue. Florida Blue offers two stand-alone Medicare Prescription Drug Plans (Part D).
Premier Rx and Complete Rx cover:
Many generic and brand-name drugs with predictable copayments
An extensive list of plan-covered drugs (formulary)
May include a low-cost mail-order pharmacy service for free home delivery of your medications
A nationwide pharmacy network
Three ways to get Medicare Part D coverage
Add Part D coverage to your Original Medicare Parts A and B coverage with a stand-alone Medicare Prescription Drug Plan (PDP).
Choose the convenience of a Medicare Advantage Prescription Drug Plan (MAPD) that includes both medical and prescription drug benefits.
Select both a Medicare Supplement Plan and a Medicare Prescription Drug Plan to add to your Original Medicare Parts A and B coverage.
What does a Medicare Part D plan cost?
Different types of costs for a Medicare Part D plan:
-
Deductible - The amount you pay before Original Medicare begins to pay its share of the cost.
-
Copay - A flat dollar amount (for example, $10) you pay each time you fill a drug.
-
Coinsurance - A percentage (for example, 10%) you pay for your prescription drugs.
-
Premium - A fixed, monthly amount you pay for your PDP coverage.
2023 Medicare Part D stages
DEDUCTIBLE STAGE
patient pays
*varies by plan
*covered drugs and costs vary from plan to plan
INITIAL COVERAGE
patient pays
$4,660
copay/coinsurance varies by plan
↓
when total spend reaches
$4,660
enter Coverage Gap
COVERAGE GAP
patient pays
25% Brands
25% Generic
*varies by plan, some plans may include drug coverage through the gap
↓
when out-of-pocket reaches
$7,400
exit Coverage Gap
CATASTROPHIC COVERAGE
patient pays
5% Brands
5% Generics
Overview of 2023 Florida Blue Medicare Prescription Drug Plans
| Features | BlueMedicare Premier Rx (PDP) | Blue Medicare Complete Rx (PDP) |
|---|---|---|
|
Formulary Tiers Covered |
Formulary Tiers 1-5 |
Formulary Tiers 1-5 |
|
Annual Deductible |
$505 (Tiers 3-5) |
$0 |
|
Initial Coverage Stage |
$4,660 |
$4,660 |
|
Catastrophic Stage |
$7,400 |
$7,400 |
|
Nationwide pharmacy network |
|
|
|
$0 select immunizations and vaccinations |
|
|
|
At-home delivery service |
|
Medicare Part D Formulary
What is a formulary?
A formulary is the list of drugs, from brand-name to generic, that are covered by a Medicare Prescription Drug Plan. Covered drugs and costs vary from plan to plan.
- Many plans have a tiered formulary, where drugs are divided into groups called "tiers" based on their cost.
- In general, the lower the formulary tier, the lower the cost to you.
- Generic drugs typically are on Tiers 1 and 2.
Part D formulary tiers:
| Tier 5 (Specialty) | $ $ $ $ $ |
| Tier 4 (Non-Preferred) | $ $ $ $ |
| Tier 3 (Preferred Brand) | $ $ $ |
| Tier 2 (Generics) | $ $ |
| Tier 1 (Preferred Generics) | $ $ |
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