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Blue MedicareRx (PDP) is a Prescription Drug Plan with a Medicare contract. Blue MedicareRx Value Plus (PDP) and Blue MedicareRx Premier (PDP) are two Medicare Prescription Drug Plans available to service residents of Connecticut, Massachusetts, Rhode Island, and Vermont.

Coverage is available to residents of the service area or members of an employer or union group and separately issued by one of the following plans: Anthem Blue Cross® and Blue Shield® of Connecticut, Blue Cross Blue Shield of Massachusetts, Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont.

*Blue MedicareRx Premier: $0 deductible applies to all covered drugs. Blue MedicareRx Value Plus: $0 deductible applies to Tier 1 Preferred Generic and Tier 2 Generic drugs.Every year, Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. Star Ratings can be found at www.medicare.govThis information is not a complete description of benefits. Contact Us for more information.

This directory is for a subset of network pharmacies identified which includes the area in which you live. However, we cover a larger service area, and there are more pharmacies where your prescriptions may be covered by our Plan. New Medicare regulations require all Part D plans to obtain patient consent before each delivery of new or refilled prescription. The typical number of days after the mail order pharmacy receives an order to receive your shipment is up to 10 days. Enrollees have the option to sign up for automated mail order delivery. If your mail order drugs do not arrive within the estimated time frames please Contact Us

[MAT ID] S2893_XXXXX [Last updated] Page Last Updated XX/XX/XXXX.

Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities which have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal.

Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are Independent Licensees of the Blue Cross and Blue Shield Association ®’, SM, TM Registered and Service Marks and Trademarks are property of their respective owners. © 2018 All Rights Reserved.

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HEADING CONTENT

Important!

If you do not enroll when you are first eligible, Medicare will likely add a late enrollment penalty to your monthly premium – that means you may pay a penalty for as long as you have Part D.

Formulary: the plan’s list of covered prescriptions, including both generic and brand-name drugs. Medicare drug plans have made agreements to get you lower prices for the drugs on their formularies, so using those drugs will generally save you money.

What is a Formulary?

Tiers: drugs are organized on the formulary by “tiers”. Generally, a drug on a lower tier will cost you less than a drug on a higher tier.

What are Tiers?

Helpful Terms

What is a Deductable?

Deductible: amount you pay each year for your prescriptions before the Part D plan starts to share costs. Some deductibles only apply to drugs on specific tiers.

For example, Sam has a plan with a $350 deductible on Tiers 3-5. When the plan begins, Sam would pay only a low copay to fill drugs on Tiers 1 and 2. But if Sam has drugs on Tiers 3-5, she would pay the $350 deductible for those drugs before the plan starts paying its share.

What is a Preferred Pharmacy Network?

Preferred pharmacy network: pharmacies that have made an agreement with the Part D plan to allow members of the plan to enjoy preferred cost-sharing (the lowest copays and coinsurance) when filling prescriptions

About Part D What it is, how you get it, and if it might be for you. Verify if Medicare drug coverage is available to you.

Learn more

When to EnrollSign-up starts before you turn 65 or are first eligible for Medicare. Generally, there are three enrollment periods.

Learn more

Coverage StagesEvery plan has them. Medicare coverage stages affect the amount you pay for each covered medication.

Learn more

Part D CostsPer year vs per month? The total estimated cost for any plan can be broken into a few types of costs.

Learn more

Choosing a PlanHow to zero in on the plan for you. Weighing your options is easier when you know what to look for.

Learn more

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Before getting into our plans and coverage, let’s take a look at the basics.

Whether you take many medications or

none at all, enrolling in Medicare

prescription drug coverage is voluntary

and it can help protect you from

unexpected high costs.

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Medicare Prescription Drug Coverage:

Start with the Basics

It’s important to understand how Medicare helps pay for medications and how it applies to

you. But we know it can be overwhelming. That’s why we are here to help you learn the

basics, before jumping into any decision-making.

Important!


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Blue MedicareRx (PDP) plans offer the value, flexibility, and support you need.

• $0 annual deductible1

• Low copays at preferred pharmacies

• Anytime support – we’re available 24/7

Blue MedicareRx Value Plus (PDP)

Affordable premiums and low copays. Even lower copays and gap coverage.

Blue MedicareRx Premier (PDP)

Compare plans



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Use your benefits anywhere. Our nationwide network gives you the ability to use your plan in all 50 states. And our preferred pharmacy network helps you save even more.

When you choose Blue, you get a broad formulary with coverage for most generics and Medicare-covered medications.

Two easy-to-use plansWhen you choose Blue, you get a broad formulary with coverage for most generics and Medicare-covered medications.

Two easy-to-use plans

Get protected with Blue MedicareRxSurprise prescription costs? Not on our watch.We understand you need drug coverage that supports you and your prescription needs. Blue MedicareRx serves the New England region with high-quality, reliable prescription drug coverage backed by the strength of Blue Cross and Blue Shield.

We have a long-standing history of providing trustworthy coverage. And we’re committed to giving you options that help you save money. With a nationwide network of more than 67,000 pharmacies, you can use your plan anywhere in the U.S. Or, you can enjoy the convenience of having your prescriptions delivered securely to your home or anywhere else you choose with CVS Caremark Mail Service Pharmacy.

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S2893_18146 Page Last Updated 09/30/2018. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities which have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal.


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• $0 annual deductible1

• Low copays at preferred pharmacies

• Anytime support – we’re available 24/7

Affordable premiums and low copays. Even lower copays and gap coverage.

When you choose Blue, you get a broad formulary with coverage for most generics and Medicare-covered medications.

1Blue MedicareRx Premier: $0 deductible applies to all covered drugs. Blue MedicareRx Value Plus: $0 deductible applies to Tier 1 Preferred Generic and Tier 2 Generic drugs

Two easy-to-use plans

Get protected with Blue MedicareRxSurprise prescription costs? Not on our watch.We understand you need drug coverage that supports you and your prescription needs. Blue MedicareRx serves the New England region with high-quality, reliable prescription drug coverage backed by the strength of Blue Cross and Blue Shield.

Blue MedicareRx Value Plus (PDP) Blue MedicareRx Premier (PDP)

Take the stress out cost comparison. Enter the drugs you take to receive a comprehensive estimate on your total cost, including premium, copays and any deductible.

Use your benefits anywhere. Our nationwide network gives you the ability to use your plan in all 50 states. And our preferred pharmacy network helps you save even more.


Get protected with Blue MedicareRx

Surprise prescription costs? Not on our watch.

We understand you need drug coverage that supports you and your prescription needs. Blue MedicareRx serves the New England region with high-quality, reliable prescription drug coverage backed by the strength of Blue Cross and Blue Shield.



• $0 annual deductible*•. Low copays at preferred pharmacies•. Anytime support – we’re available 24/7

Two easy-to-use plansWhen you choose Blue, you get a broad formulary with coverage for most generics and Medicare-covered medications.

Blue MedicareRx Value Plus (PDP) Affordable premiums and low copays.

*Blue MedicareRx Premier: $0 deductible applies to all covered drugs. Blue MedicareRx Value Plus: $0 deductible applies to Tier 1 Preferred Generic and Tier 2 Generic drugs

Blue MedicareRx Premier (PDP)

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Even lower copays and gap coverage.




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• the plan formulary (drug list)• ways to lower what I pay for medications• what to do now that my drug was removed from the formulary• my account login

• print a temporary ID card• report fraud• make a complaint• disenroll from my Blue MedicareRx plan

Discover the information you’re looking for, so you can quickly get back to what’s important to you. Access resources that help you manage your plan, such as guidance on automatic premium payments and an introduction to your Caremark.com account. Or, download the documents you need from our most-downloaded documents. Click on the link to get started.

I want to…• find out what a new prescription will cost• see my in-network pharmacy options• have prescriptions delivered• set up automatic premium payments

I am looking for…

I need to…

If you don’t see the information you’re looking for, our Customer Care team is available 24/7 to answer your call. XXX-XXX-XXXX. TTY 711.


Summary of Benefits

Blue MedicareRx Value Plus Comprehensive Formulary

Blue MedicareRx Premier Comprehensive Formulary

Prescription Claim Form

Coverage Determination Request Form

Most frequently used documents

Appointment of Representative Form

>More documents

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Here for you when you need us

• the plan formulary (drug list)• ways to lower what I pay for

medications• what to do now that my drug was removed from the formulary• my account login

• print a temporary ID card• report fraud• make a complaint• disenroll from my Blue MedicareRx plan

Discover the information you’re looking for, so you can quickly get back to what’s important to you. Access resources that help you manage your plan, such as guidance on automatic premium payments and an introduction to your Caremark.com account. Or, download the documents you need from our most-downloaded documents. Click on the link to get started.

I want to…

• find out what a new prescription will cost

• see my in-network pharmacy options• have prescriptions delivered• set up automatic premium payments

I am looking for…

I need to…

If you don’t see the information you’re looking for, our Customer Care team is available 24/7 to answer your call.

XXX-XXX-XXXX TTY 711

Summary of Benefits

Blue MedicareRx Value Plus Comprehensive Formulary

Blue MedicareRx Premier Comprehensive Formulary

Prescription Claim Form

Coverage Determination Request Form

Most frequently used documents

Appointment of Representative Form

>More documents

The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members.

Formulary (drug list)

Home Formulary (drug list)

Formulary tiers

Drugs on the formulary are organized by tiers. Generally, a drug on a lower tier will cost less than a drug on a higher tier. If you’re interested in saving money on your prescriptions, discuss with your doctor whether switching to a similar drug on a lower tier might work for you.

Tier assignments vary by plan. Use the Drug Pricing Tool to price the medications you are currently taking and see which Blue MedicareRx plan is best for you.

Formulary updates

Formulary coverage requests

Drugs not covered under Medicare

Blue MedicareRx formularies may change during a calendar year if we remove a drug, change a drug’s tier, or add a special coverage requirement. If a change affects a drug you take, we will notify you at least 60 days in advance, as required by Medicare.

Sometimes, we must remove a drug immediately for safety reasons or due to its discontinuation by the manufacturer. If a sudden removal occurs, we will notify our affected members as soon as possible.View the upcoming formulary changes for Blue MedicareRx Value Plus (PDP), PDF and Blue MedicareRx Premier (PDP), PDF.

Certain drugs on Blue MedicareRx formularies have special coverage requirements to ensure they’re used in a safe way and to help control costs. These requirements include: • Prior authorization – you will need to obtain approval before you fill your prescription • Quantity limit – There is a limit to the amount of the drug the plan will cover with each prescription filled • Step therapy – You may be required to try an alternative drug before this drug is covered • Limited access – This prescription may be available only at certain pharmaciesIf you believe your use of a drug meets all special requirements, or that you should be exempt from a requirement, you and/or your doctor must request a coverage determination before the plan will cover your drug. You can also request that the plan cover a drug that is not included in the formulary.

There are certain types of drugs that Blue MedicareRx cannot include in the formulary due to federal law, including: • Non-prescription drugs (also called over-the-counter drugs). • Drugs for treatment of anorexia, weight loss or weight gain. • Drugs to promote fertility. • Drugs for cosmetic purposes or hair growth. • Drugs to relieve a cough or cold symptoms. • Prescription vitamins and minerals (except for prenatal vitamins and fluoride preparations). • Drugs for treatment of sexual or erectile dysfunction (ED).

In addition, a Medicare Part D plan cannot cover: • Drugs that would be covered under Medicare Part A or Part B. • Drugs not approved by the U.S. Food and Drug Administration (FDA). • Off-label drug use, which means using a drug for treatments not specifically mentioned on the drug’s label.

Coverage

Description Tier

Certain generic drugs that are available at the lowest copayment for our membersTier 1

Higher cost generic drugs available at a higher copayment than Tier 1 generic drugsTier 2

Common brand-name and some higher cost generic drugsTier 3

High cost generic and non-preferred drugs, many of which may have lower cost options available on Tier 1, 2 or 3

Tier 4

Unique and/or very high-cost brand and some generic drugs of which you pay a percentage of the drug cost; some may require special handling and/or close monitoring

Tier 5

Contact UsFrequently Asked Questions

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Updated Mat Id S2893_XXXXX Page Last Updated XX/XX/2019. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities which have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal.





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Home Formulary (drug list)Coverage

The formulary, also known as a drug list, for each Blue MedicareRx plan includes most eligible generic and brand-name drugs. All the drugs we cover are carefully selected to provide the greatest value while meeting the needs of our members.

Drugs on the formulary are organized by tiers.Generally, a drug on a lower tier will cost less than a drug on a higher tier. If you’re interested in saving money on your prescriptions, discuss with your doctor whether switching to a similar drug on a lower tier might work for you.

Description Tier

Certain generic drugs that are available at the lowest copayment for our members

Tier 1

Higher cost generic drugs available at a higher copayment than Tier 1 generic drugs

Tier 2

Common brand-name and some higher cost generic drugs

Tier 3

High cost generic and non-preferred drugs, many of which may have lower cost options available on Tier 1, 2 or 3

Tier 4

Unique and/or very high-cost brand and some generic drugs of which you pay a percentage of the drug cost; some may require special handling and/or close monitoring

Tier 5

Tier assignments vary by plan. Use the Drug Pricing Tool to price the medications you are currently taking and see which Blue MedicareRx plan is best for you.

• Prior authorization – you will need to obtain approval before you fill your prescription• Quantity limit – There is a limit to the amount of the drug the plan will cover with each prescription filled• Step therapy – You may be required to try an alternative drug before this drug is covered• Limited access – This prescription may be available only at certain pharmacies

If you believe your use of a drug meets all special requirements, or that you should be exempt from a requirement, you and/or your doctor must request a coverage determination before the plan will cover your drug. You can also request that the plan cover a drug that is not included in the formulary.

Certain drugs on Blue MedicareRx formularies have special coverage requirements to ensure they’re used in a safe way and to help control costs. These requirements include:

There are certain types of drugs that Blue MedicareRx cannot include in the formulary due to federal law, including:

In addition, a Medicare Part D plan cannot cover:

• Non-prescription drugs (also called over-the- counter drugs).• Drugs for treatment of anorexia, weight loss or weight gain.• Drugs to promote fertility.• Drugs for cosmetic purposes or hair growth.• Drugs to relieve a cough or cold symptoms.• Prescription vitamins and minerals (except for prenatal vitamins and fluoride preparations).• Drugs for treatment of sexual or erectile dysfunction (ED).

• Drugs that would be covered under Medicare Part A or Part B.• Drugs not approved by the U.S. Food and Drug Administration (FDA).• Off-label drug use, which means using a drug for treatments not specifically mentioned on the drug’s label.

Blue MedicareRx formularies may change during a calendar year if we remove a drug, change a drug’s tier, or add a special coverage requirement. If a change affects a drug you take, we will notify you at least 60 days in advance, as required by Medicare.

Sometimes, we must remove a drug immediately for safety reasons or due to its discontinuation by the manufacturer. If a sudden removal occurs, we will notify our affected members as soon as possible.View the upcoming formulary changes for Blue MedicareRx Value Plus (PDP), PDF and Blue MedicareRx Premier (PDP), PDF.

Formulary updates

Formulary coverage requests

Drugs not covered under Medicare

Formulary tiers

Enter your zip code into our Pharmacy Locator to quickly find the closest preferred cost-sharing pharmacies near you.

Locate a Blue MedicareRx pharmacy

Take the guesswork out of comparing plans with our drug pricing tool. Enter your medications to verify coverage and see your total cost for both plans.

Estimate your drug costs

Drug and Pharmacy Network CoverageExplore how a Blue MedicareRx plan would work for you. Our prescription drug plans (PDPs) offer cover most Medicare-Eligible drugs through a large pharmacy network.

Comprehensive Drug Coverage

Every medication we cover is assigned to one of five drug tiers on our list of drugs, also known as a formulary. Drugs on lower tiers are mostly generics and will generally cost less than brand drugs found on higher tiers. Some drugs may require prior authorization or that you meet other special requirements before they are covered.

With over 67,000 pharmacies, including large chains and independent pharmacies, you can travel anywhere in the United States and still have access to your medications. Choose from among our 36,000 preferred cost-sharing pharmacies or use our convenient mail service pharmacy to get the greatest cost savings.

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Preferred PharmaciesMore than 36,000 pharmacy locations in our nationwide network offer preferred cost-sharing savings for Blue MedicareRx members. This means your out-of-pocket costs on prescriptions will be lower at these pharmacies than at standard cost-sharing pharmacies.

Mail ServiceWith Blue MedicareRx (PDP), you can take advantage of the convenience of CVS Caremark Mail Service Pharmacy and have your drugs delivered directly to your door at any location in the U.S. You can save over 70% on Tier 1 drugs, and a 90-day supply of Tier 2 and 3 drugs will cost less than filling them at a retail pharmacy. Standard shipping is free.1

Blue MedicareRx (PDP) has more than 67,000 pharmacies in our nationwide network, including national chains, independent pharmacies, long-term care pharmacies, home-infusion pharmacies and Indian Health/Tribal pharmacies. Try our easy-to-use Pharmacy Locator to find a network pharmacy near you.

You must use a network pharmacy to access your prescription drug benefits, except under special circumstances, such as a medical emergency. Prescriptions filled at non-network pharmacies may cost more than when the same drugs are filled through a network pharmacy.

Savings and Convenience from your Plan’s Pharmacy Network

Home Pharmacy Network

To request a printed copy of our pharmacy directory call us, 24 hours a day, 7 days a week. Contact Us

1 Percent savings based on copays on Tier 1 drugs obtained through CVS Caremark Mail Service Pharmacy vs. copays on Tier 1 drugs obtained through a Blue MedicareRx Preferred Network Pharmacy. Call Customer Care for specific pricing of your medications. Typically, you should expect to receive your prescription within 10 calendar days from the time the mail service pharmacy receives your order.

Coverage

Out-of-network coverage

Blue MedicareRx network pharmacies are available nationwide. However, we understand that you may need to use a pharmacy outside our network in extenuating circumstances, such as a medical emergency, need for a 24-hour pharmacy or immediate need for an out-of-stock medication. In these cases, the plan may cover your drug, but you may pay more than you would have paid at a network pharmacy.

If you use an out-of-network pharmacy, you will need to pay the full cost of your prescription and then request reimbursement. To request reimbursement, submit a Prescription Claim Form, along with the receipt for your covered drug. If reimbursement is approved, we will send a payment to you within 30 days after your request is approved.










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With Blue MedicareRx (PDP), you can take advantage of the convenience of CVS Caremark Mail Service Pharmacy and have your drugs delivered directly to your door at any location in the U.S. You can save over 70% on Tier 1 drugs, and a 90-day supply of Tier 2 and 3 drugs will cost less than filling them at a retail pharmacy. Standard shipping is free.1










Change State

Home Pharmacy NetworkCoverage



Mail Service

Preferred PharmaciesMore than 36,000 pharmacy locations in our nationwide network offer preferred cost-sharing savings for Blue MedicareRx members. This means your out-of-pocket costs on prescriptions will be lower at these pharmacies than at standard cost-sharing pharmacies.






Locate the closest preferred cost-sharing pharmacy >

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Help Paying your Plan Premiums and Pharmacy Costs

A lower monthly premium helps control your Medicare Part D costs

If you get Extra Help from Medicare, you pay lower prices for your medications. In addition, your monthly prescription drug plan premium will be lower if you are in the Extra Help program.* The amount for your monthly Blue MedicareRx (PDP) premium will depend on the amount of Extra Help you receive.










Additional Resources/links to gov website or can hold contact info shown top right



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Extra Help Contact Info

Help Paying your Plan Premiums and Pharmacy Costs

A lower monthly premium helps control your Medicare Part D costs

If you get Extra Help from Medicare, you pay lower prices for your medications. In addition, your monthly prescription drug plan premium will be lower if you are in the Extra Help program.* The amount for your monthly Blue MedicareRx (PDP) premium will depend on the amount of Extra Help you receive.

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Enroll Online

Download a paper enrollment application and return it by mail

Send your completed application toBlue MedicareRx PDPP.O. Box 30001Pittsburgh, PA 15222-0330

Enroll by Phone

Connecticut Residents1-866-832-9702 (TTY: 711)24 hours a day, 7 days a week

Massachusetts Residents1-800-678-2265 (TTY: 711)10/1 - 3/31 8 a.m. to 8 p.m. 7 days a week4/1 - 9/30 8 a.m. to 8 p.m. Monday - Friday

Rhode Island Residents1-800-505-2583 (TTY: 711)24 hours a day, 7 days a week

Vermont Residents1-888-496-4178 (TTY: 711)24 hours a day, 7 days a week

Enroll through Medicare’s websiteMedicare beneficiaries may also enroll in Blue MedicareRx through the CMS Medicare Online Enrollment Center located at www.medicare.gov.

Blue MedicareRx (PDP) Enrollment OptionsChoose what works best for you. There are four ways to enroll:

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Enroll OnlineEnroll Online

Enroll by Phone

Connecticut Residents1-866-832-9702 (TTY: 711)24 hours a day, 7 days a week

Massachusetts Residents1-800-678-2265 (TTY: 711)10/1 - 3/31 8 a.m. to 8 p.m. 7 days a week4/1 - 9/30 8 a.m. to 8 p.m. Monday - Friday

Rhode Island Residents1-800-505-2583 (TTY: 711)24 hours a day, 7 days a week

Vermont Residents1-888-496-4178 (TTY: 711)24 hours a day, 7 days a week

Download a paper enrollment application and return it by mailSend your completed application toBlue MedicareRx PDPP.O. Box 30001Pittsburgh, PA 15222-0330

Enroll through Medicare’s websiteMedicare beneficiaries may also enroll in Blue MedicareRx through the CMS Medicare Online Enrollment Center located at www.medicare.gov.










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About Blue MedicareRx (PDP)Bringing peace of mind from our family to yoursBlue MedicareRx (PDP) is a prescription drug plan backed by Blue Cross Blue Shield and a long-standing history of offering you high-quality service and support. When you choose us for your Medicare Part D coverage, you’ll be part of a family you can rely on and trust. You can rest assured knowing that we proudly serve more than 6.9 million Medicare members like you nationwide.

Our commitment to our members is one of the reasons why Blue MedicareRx is the only PDP plan in New England to achieve a 5-Star plan rating from Medicare for: • Drug Plan Customer Service• Member Complaints and Changes in Drug Plan’s Performance

Reasons you become eligible for your IEP include:• You are turning 65. You have 7 months to sign up: the 3 months before your birthday, the month of your birthday, and the 3 months after your birthday.• You have 7 months to sign up: the 3 months before your 25th month of getting disability benefits, the 25th month of getting disability benefits, and the 3 months after your 25th month of getting disability benefits.

Annual Enrollment Period (AEP)Each year between October 15 and December 7, you have the option to enroll in Part D for the first time, or to change your current drug coverage for the next year. Special Enrollment Period (SEP)There are many enrollment opportunities based on a change to your location or situation, rather than the time of the year. A few examples include:

• You are enrolling into a 5 STAR Medicare Prescription Drug Plan.• You permanently move into the Blue MedicareRx plan’s service area, which is Connecticut, Massachusetts, Rhode Island, and Vermont.• You lose employer group prescription drug coverage.• You are enrolled in a plan by Medicare (or your state), and you want to choose a different plan.

Other situations that are not listed here could qualify you for a special enrollment period. For questions about eligibility or to find out if your situation could qualify you for an SEP, call our dedicated team of experts today.

Eligibility Based on Disability

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MEDICARE PART DWhat is Medicare Part D prescription drug coverage?Medicare Part D prescription drug coverage is insurance that:• helps to pay for prescription drugs at participating pharmacies• provides coverage to help offset the cost of prescription drugs• helps to pay for unexpected prescription drug costsAs a federal program, Medicare Part D was enacted as a part of the Medicare Modernization Act of 2003. It officially went into effect on January 1, 2006.

Medicare Part D is available as stand-alone coverage (also called Prescription Drug Plan or PDP), or as a prescription drug benefit added to a Medicare Part C plan (MA-PD).

Medicare Part D prescription drug coverage is only available through private insurance companies that are approved by Medicare. Blue MedicareRx is a provider of stand-alone prescription drug coverage. Beneficiaries can choose the drug plan they want and pay a monthly premium.

Am I eligible for Medicare prescription drug coverage?You are eligible to enroll in a Medicare Prescription Drug Plan if you are entitled to Medicare Part A and/or enrolled in Part B.In addition, you must be:• Age 65 or older, or• Under age 65 with qualifying disabilities, or• Have been diagnosed with End-Stage Renal Disease (permanent kidney failure requiring a kidney transplant or dialysis, also written as ESRD).You may choose a stand-alone prescription drug plan or prescription drug coverage offered with a Medicare Advantage plan, but you may only be enrolled in one Medicare prescription drug plan at a time. Those who have Medicare prescription drug coverage eligibility must enroll in a plan during a proper Election period.

How can I receive extra help from Medicare?The Medicare Extra Help program is designed to help people who may not be able to afford prescription drug coverage by assisting with the costs of a Part D plan. This may include premiums, deductibles and/or coinsurance.*

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call:• 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048, 24 hours a day, 7 days a week, or• Social Security Administration at 1-800-772-1213 between 7a.m. and 7p.m., Monday through Friday (TTY users should call 1-800-325-0778), or• Your State Medicaid Office.

*You must continue to pay your Medicare Part B premium.

Is there Medicare Extra Help available for things other than prescription benefits?If you need additional Extra Help, please view BenefitsCheckup.org, a site developed and maintained by the National Council on Aging (NCOA). BenefitsCheckup.org provides those with limited resources a web-based service that screens for benefits programs and lets you know how and where to apply for them. Millions of people have already received additional assistance by BenefitsCheckup.org.

Click BenefitsCheckup.org for links that can help, such as applying for Extra Help from Medicare.

What is the Medicare Part D IRMAA?The Income-Related Monthly Adjustment Amount or “IRMAA” applies to Medicare beneficiaries with high incomes. For example, if your 2017 reported yearly income as a single taxpayer is greater than $85,000, (greater than $170,000 filing jointly), you will be responsible for paying an additional $12.40. This is in addition to your monthly premium. The IRMAA will be further adjusted as income levels increase. Important points about the Part D IRMAA to keep in mind:• If you owe an IRMAA, Social Security will send you a letter notifying you that the extra amount you owe will be added to your Medicare Part D premium.• The Part D IRMAA is billed directly by the Centers for Medicare and Medicaid Services, which means any IRMAA payment should not be sent to your prescription drug plan.• If you do not pay your IRMAA, you risk disenrollment from your Medicare Part D plan.• More information about the Part D IRMAA can be found on Medicare’s website.

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When can I enroll in a Medicare prescription drug plan?What is the Medicare Part D late enrollment penalty?When can I make changes to my Medicare prescription drug coverage?

Enrollment

What is Medicare Part D prescription drug coverage?Am I eligible for Medicare prescription drug coverage?How can I receive extra help from Medicare?Is there Medicare Extra Help available for things other than prescription benefits?What is the Medicare Part D IRMAA?

Medicare Part D

How do I know if my drug is covered?My drug is not on my plan’s formulary, or is on the formulary, but has a requirement/limitation that my current usage does not meet. What should I do?What is a coverage determination?I received notice that my current drug is no longer covered or has a new requirement/limitation that my current usage does not meet. What should I do?How can I find out what drugs may be less expensive but still effective for my treatment?Blue MedicareRx and/or Caremark.com recommended a different drug than the one I’m already taking. Do I have to change to the recommended drug?

Drug Coverage

Why does my Blue MedicareRx plan have a Coverage Gap?Is there any way I can avoid the Coverage Gap?

Medicare Coverage Gap

What is a Medicare Part D network pharmacy and can I use a pharmacy not in the network?What is a preferred cost-sharing pharmacy in the Blue MedicareRx network?What is a Standard cost-sharing Pharmacy in the Blue MedicareRx network?What if there isn’t a Medicare Part D preferred cost-sharing pharmacy near me?

Pharmacy Networks

How long does it take to get started with mail service?What information do I need to start delivery by mail at Caremark.com?How does the mail service pharmacy get my prescription?What do I do if my doctor’s office does not respond to the mail service pharmacy’s request?Are all of my medications eligible for delivery by mail?How do I pay for my mail order prescriptions? Will my prescription refills be shipped as soon as they’re ready? How do I stop delivery by mail?

Mail Service Pharmacy

What is Caremark.com and why does Blue MedicareRx want members to use it?Is the pricing I see on the Caremark.com website accurate?

Using Caremark.com

How do I set up automatic premium payments?Why did I receive a bill in the mail after signing up for automatic premium payments?Can I cancel or change my automatic payment method?I haven’t received my first invoice to pay my monthly premium. When can I expect it?When are my premium payments due?Can I send one check to pay for more than one member’s premiums?I’m having difficulty paying for my prescription drug plan. What can I do?

Paying my Monthly Premium

How can I change my address, phone number or email?How do I designate an Appointed Representative to act on my behalf?

Personal & Contact Information

What is the difference between the online EOB statements and the statement I currently receive in the mail?Why don’t you just email my statement to me as an attachment?What do I do if I need a paper copy of my statement?What happens if my computer crashes? Do I lose all of my statements?

Online Explanation of Benefits (EOB)

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Medicare Part D

Enrollment

Drug Coverage


Pharmacy Networks


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Medicare Part D prescription drug coverage is insurance that:

• helps to pay for prescription drugs at participating pharmacies

• provides coverage to help offset the cost of prescription drugs

• helps to pay for unexpected prescription drug costs

As a federal program, Medicare Part D was enacted as a part of the Medicare Modernization Act of 2003. It officially went into effect on January 1, 2006. Medicare Part D is available as stand-alone coverage (also called Prescription Drug Plan or PDP), or as a prescription drug benefit added to a Medicare Part C plan (MA-PD).


What is Medicare Part D prescription drug coverage?

You are eligible to enroll in a Medicare Prescription Drug Plan if you are entitled to Medicare Part A and/or enrolled in Part B.

In addition, you must be:

• Age 65 or older, or

• Under age 65 with qualifying disabilities, or

• Have been diagnosed with End-Stage Renal Disease (permanent kidney failure requiring a kidney transplant or dialysis, also written as ESRD).

You may choose a stand-alone prescription drug plan or prescription drug coverage offered with a Medicare Advantage plan, but you may only be enrolled in one Medicare prescription drug plan at a time. Those who have Medicare prescription drug coverage eligibility must enroll in a plan during a proper Election period.

Am I eligible for Medicare prescription drug coverage?

How can I receive extra help from Medicare?

Is there Medicare Extra Help available for things other than prescription benefits?

What is the Medicare Part D IRMAA?

When can I enroll in a Medicare prescription drug plan?

How do I know if my drug is covered?

My drug is not on my plan’s formulary, or is on the formulary, but has a requirement/limitation that my current usage does not meet. What should I do?

What is a coverage determination?

I received notice that my current drug is no longer covered or has a new requirement/limitation that my current usage does not meet. What should I do?

How can I find out what drugs may be less expensive but still effective for my treatment?

Blue MedicareRx and/or Caremark.com recommended a different drug than the one I’m already taking. Do I have to change to the recommended drug?

Why does my Blue MedicareRx plan have a Coverage Gap?

Is there any way I can avoid the Coverage Gap?

What is a Medicare Part D network pharmacy and can I use a pharmacy not in the network?

How long does it take to get started with mail service?

What information do I need to start delivery by mail at Caremark.com?

How does the mail service pharmacy get my prescription?

What do I do if my doctor’s office does not respond to the mail service pharmacy’s request?

Are all of my medications eligible for delivery by mail?

How do I pay for my mail order prescriptions?

Will my prescription refills be shipped as soon as they’re ready?

What is Caremark.com and why does Blue MedicareRx want members to use it?

Is the pricing I see on the Caremark.com website accurate?

What is the difference between the online EOB statements and the statement I currently receive in the mail?

Why don’t you just email my statement to me as an attachment?

What do I do if I need a paper copy of my statement?

What happens if my computer crashes? Do I lose all of my statements?

How do I set up automatic premium payments?

Why did I receive a bill in the mail after signing up for automatic premium payments?

Can I cancel or change my automatic payment method?

I haven’t received my first invoice to pay my monthly premium. When can I expect it?

When are my premium payments due?

Can I send one check to pay for more than one member’s premiums?

I’m having difficulty paying for my prescription drug plan. What can I do?

How can I change my address, phone number or email?

How do I designate an Appointed Representative to act on my behalf?

What is a preferred cost-sharing pharmacy in the Blue MedicareRx network?

What is a Standard cost-sharing Pharmacy in the Blue MedicareRx network?

What if there isn’t a Medicare Part D preferred cost-sharing pharmacy near me?

What is the Medicare Part D late enrollment penalty?

When can I make changes to my Medicare prescription drug coverage?

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Medicare Part D

Medicare Part D prescription drug coverage is insurance that:

• helps to pay for prescription drugs at participating pharmacies

• provides coverage to help offset the cost of prescription drugs

• helps to pay for unexpected prescription drug costs

As a federal program, Medicare Part D was enacted as a part of the Medicare Modernization Act of 2003. It officially went into effect on January 1, 2006. Medicare Part D is available as stand-alone coverage (also called Prescription Drug Plan or PDP), or as a prescription drug benefit added to a Medicare Part C plan (MA-PD).





Is there Medicare Extra Help available for things other than prescription benefits?What is the Medicare Part D IRMAA?

Enrollment

When can I enroll in a Medicare prescription drug plan?

What is the Medicare Part D late enrollment penalty?

When can I make changes to my Medicare prescription drug coverage?

Drug Coverage

How do I know if my drug is covered?

My drug is not on my plan’s formulary, or is on the formulary, but has a requirement/limitation that my current usage does not meet. What should I do?What is a coverage determination?

I received notice that my current drug is no longer covered or has a new requirement/limitation that my current usage does not meet. What should I do?

How can I find out what drugs may be less expensive but still effective for my treatment?

Blue MedicareRx and/or Caremark.com recommended a different drug than the one I’m already taking. Do I have to change to the recommended drug?


Pharmacy Networks

What is a Medicare Part D network pharmacy and can I use a pharmacy not in the network?

What is a preferred cost-sharing pharmacy in the Blue MedicareRx network?

What is a Standard cost-sharing Pharmacy in the Blue MedicareRx network?

What if there isn’t a Medicare Part D preferred cost-sharing pharmacy near me?


Using Caremark.com



Personal & Contact

Information

Why does my Blue MedicareRx plan have a Coverage Gap?

Is there any way I can avoid the Coverage Gap?

How long does it take to get started with mail service?

What information do I need to start delivery by mail at Caremark.com?

How does the mail service pharmacy get my prescription?

What do I do if my doctor’s office does not respond to the mail service pharmacy’s request?

Are all of my medications eligible for delivery by mail?

How do I pay for my mail order prescriptions?

Will my prescription refills be shipped as soon as they’re ready?

What is Caremark.com and why does Blue MedicareRx want members to use it?

Is the pricing I see on the Caremark.com website accurate?

What is the difference between the online EOB statements and the statement I currently receive in the mail?

Why don’t you just email my statement to me as an attachment?

What do I do if I need a paper copy of my statement?

What happens if my computer crashes? Do I lose all of my statements?

How do I set up automatic premium payments?

Why did I receive a bill in the mail after signing up for automatic premium payments?

Can I cancel or change my automatic payment method?

I haven’t received my first invoice to pay my monthly premium. When can I expect it?

When are my premium payments due?

Can I send one check to pay for more than one member’s premiums?

I’m having difficulty paying for my prescription drug plan. What can I do?

How can I change my address, phone number or email?

How do I designate an Appointed Representative to act on my behalf?

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Medicare Part D

What is Medicare Part D prescription drug coverage?What is Medicare Part D prescription drug coverage?




Is there Medicare Extra Help available for things other than prescription benefits?

What is the Medicare Part D IRMAA?

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Drug Coverage


Pharmacy Networks

Enrollment

Using Caremark.com




Medicare Part D

What is Medicare Part D prescription drug coverage? Medicare Part D prescription drug coverage is insurance that:

• helps to pay for prescription drugs at participating pharmacies • provides coverage to help offset the cost of prescription drugs • helps to pay for unexpected prescription drug costs

As a federal program, Medicare Part D was enacted as a part of the Medicare Modernization Act of 2003. It officially went into effect on January 1, 2006. Medicare Part D is available as stand-alone coverage (also called Prescription Drug Plan or PDP), or as a prescription drug benefit added to a Medicar e Part C plan (MA -PD). Medicare Part D prescription drug coverage is only available through private insurance companies that are approved by Medicare. Blue MedicareRx is a provider of stand-alone prescription drug coverage. Beneficiaries can choose the dr ug plan they want and pay a monthly premium.










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Choosing a Medicare Part D plan that is right for you.




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Medicare Part D Helps You Save on Prescriptions

If your income is limited and you qualify for Medicare’s “Extra Help”

program. Medicare beneficiaries who qualify for Extra Help pay very low

costs for their medications.

Medicare’s Extra Help program:

You can get Medicare Part D in two ways:

• A Medicare Advantage (MA) plan that includes Part D. Not all MA plans include Part D coverage.

• Or, a standalone Part D prescription drug plan (PDP) to go along with your Medicare Supplement plan or Original Medicare.

Medicare Part D is drug coverage that can help lower your costs of the

Medicare-covered medications you take now, as well as the ones you

may take in the future. You can only enroll in a Part D plan offered by

private insurance companies such as Blue Cross.

Medicare Part D is for anyone in these situations:

• If you have Medicare Part A or Part B, regardless of health or income status.

• If you are turning 65. In most cases, you must first enroll around your 65th birthday. If you don’t sign up for drug coverage when you first become eligible, you may have to pay a late penalty that adds to your monthly premiums as long as you have Part D.


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Determining Medicare Part D Eligibility and When to Enroll

You are most likely eligible for Medicare Part D if you are eligible for

Medicare and you are enrolled in either Medicare Part A or Medicare

Part B. You can enroll in Blue MedicareRx if you permanently reside in

Connecticut, Massachusetts, Rhode Island, or Vermont and are not

enrolled in another Medicare Part D prescription drug plan or a

Medicare Advantage plan with Part D coverage.

When you can enroll for Medicare Part D Coverage

There are three opportunities, or enrollment periods, to enroll in a Part

D plan. It’s important to understand which ones may apply to you, so

you always have the right coverage at the right time.

Initial Enrollment Period

When you first become eligible for Medicare, you have a 7-month initial

enrollment period (IEP). If you don’t sign up in your IEP, you may have

to pay a late enrollment penalty every month for as long as you have a

Part D plan.

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Reasons you become eligible for your IEP include:

• You are turning 65. You have 7 months to sign up: the 3 months before your birthday, the month of your birthday, and the 3 months

after your birthday.

• You have a disability or end-stage renal disease. Your can sign up starting in the 3 months before your disability or renal disease

through the 3 months after your 25th month of disability.

Annual Enrollment Period (AEP)

Each year, Part D open enrollment begins on October 15 and ends on December 7. It gives you the option to change your drug coverage

for the start of the New Year or enroll for the first time.

Special Enrollment Period

There are many enrollment opportunities based on a change to your location or situation, rather than the time of the year. A few

examples include:

• You are enrolling into a 5 STAR Medicare Prescription Drug Plan.

• You permanently move into the Blue MedicareRx plan’s service area, which is Connecticut, Massachusetts, Rhode Island, and

Vermont.

• You lose employer group prescription drug coverage.

• You are enrolled in a plan by Medicare (or my state) and I want to choose a different plan.

Your situation may qualify you for a special enrollment period that is not listed here. For questions about eligibility and more information

about special enrollment, call our dedicated team of experts today.


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Annual Deductible

Initial Coverage

Begins: when your out-of-pocket costs reach $5,100 on covered drugs.

After your out-of-pocket costs total $5,100, you exit the gap and get

catastrophic coverage. Under catastrophic coverage, you pay only a

small coinsurance amount or copayment for prescription drugs.

Catastrophic Coverage

Begins: when you and your plan have spent $3,820 on covered drugs.

Not everyone will enter the coverage gap (“donut hole”).

In the coverage gap, the plan is temporarily limited in how much it can pay for

your drugs. If you do enter the gap, you’ll pay 25% of the plan’s cost for

covered brand-name prescription drugs and 37% of the plan’s cost for

covered higher cost generic drugs.

You exit the coverage gap when your total out-of-pocket costs (not including

premiums) reach $5,100. Your out-of-pocket cost is totaled by adding

together all of the following: yearly deductible, coinsurance, and

copayments from the entire plan year; what you pay for drugs in the

coverage gap; and the discount you get on brand-name drugs in the

coverage gap.

Coverage Gap

Understanding The Four Coverage Stages of Medicare’s Part D Program

Throughout the year, your prescription drug plan costs may change depending on the

coverage stage you are in. If you have a Part D plan, you move through the coverage

stages in this order: deductible, initial coverage, coverage gap, and catastrophic

coverage.

LINK TO NEXT STEP


Begins: when your prescription payments add up to equal your

deductible.

Your plan pays for a portion of each prescription drug, as long as it is covered.

You pay the other portion, which is either a copayment (a set dollar

amount) or coinsurance (a percentage). You exit initial coverage when

your prescription spending adds up to equal Medicare’s initial coverage

limit. The monthly premium payments you make are not counted toward

reaching the limit.

Begins: with your first prescription of the plan year.

You pay the full cost of your prescriptions until your spending adds up to the

amount of your deductible. So, if your plan has a $0 deductible, you

skip straight to the next stage. Keeping in mind that some deductibles

may only apply to drugs in specific tiers. The monthly premium

payments you make are not counted toward reaching your deductible.

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• A Medicare Advantage (MA) plan that includes Part D. Not all

MA plans include Part D coverage.

• Or, a standalone Part D prescription drug plan (PDP) to go

along with your Medicare Supplement plan or Original

Medicare.

• If you have Medicare Part A or Part B, regardless of health or

income status.

• If you are turning 65. In most cases, you must first enroll around

your 65th birthday. If you don’t sign up for drug coverage when you

first become eligible, you may have to pay a late penalty that adds to

your monthly premiums as long as you have Part D.



Medicare Part D is drug coverage that can help lower your costs of the Medicare-

covered medications you take now, as well as the ones you may take in the future.

You can only enroll in a Part D plan offered by private insurance companies such as

Blue Cross.

If your income is limited and you qualify for Medicare’s “Extra Help” program. Medicare beneficiaries who qualify for Extra Help pay

very low costs for their medications.

Medicare’s Extra Help program


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If your income is limited and you qualify for Medicare’s “Extra Help” program.

Medicare beneficiaries who qualify for Extra Help pay very low costs for their

medications.

Medicare’s Extra Help program



• A Medicare Advantage (MA) plan that includes Part D. Not all MA plans include

Part D coverage.

• Or, a standalone Part D prescription drug plan (PDP) to go along with your

Medicare Supplement plan or Original Medicare.

• If you have Medicare Part A or Part B, regardless of health or income status.

• If you are turning 65. In most cases, you must first enroll around your 65th

birthday. If you don’t sign up for drug coverage when you first become eligible,

you may have to pay a late penalty that adds to your monthly premiums as

long as you have Part D.


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Medicare Part D is drug coverage that can help lower

your costs of the Medicare-covered medications you take

now, as well as the ones you may take in the future.

You can only enroll in a Part D plan offered by private

insurance companies such as Blue Cross.





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Make a list of your medications and dosage

Talk to your doctor if you’re unsure about including a medication or about

potential generic alternatives. Switching to a generic alternative could save

you money at the pharmacy counter.

• Look for plans that cover all your medications. Sometimes, a drug’s

generic alternative is covered, but the brand-name drug is not

covered.

• Look for a five star rating. STAR Ratings is how the Centers for

Medicare & Medicaid Services (CMS) rates prescription drug plans

based on what’s important to members.

• Compare the plan’s costs: premium, deductible, copayments, and

coinsurance. A $0 deductible with a higher premium means you may

have more consistent monthly payments, while a higher deductible

with a lower premium means you may pay more at the beginning of

your plan.

• Look at the nearby pharmacies in the plan’s network. An in-network

pharmacy will usually save you more money. If you travel during the

year, look for a nationwide network. And if you prefer to have your

medications delivered to you, some plan offers mail service.

Review plan coverage options based on your individual needs

Choosing a Medicare Part D Plan with Confidence

Finding the Part D plan that’s right for you starts with gathering information on your

needs and on the plans you are considering.



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Initial Enrollment Period

The Three Enrollment Periods

Annual Enrollment Period (AEP)

There are many enrollment opportunities based on a change to your location

or situation, rather than the time of the year. A few examples include:

• You are enrolling into a 5 STAR Medicare Prescription Drug Plan.

• You permanently move into the Blue MedicareRx plan’s service area, which

is Connecticut, Massachusetts, Rhode Island, and Vermont.

• You lose employer group prescription drug coverage.

• You are enrolled in a plan by Medicare (or my state) and I want to choose a

different plan.

Special Enrollment Period

Determining Medicare Part D Eligibility and When to Enroll

You are most likely eligible for Medicare Part D if you are eligible for Medicare and you are

enrolled in either Medicare Part A or Medicare Part B. You can enroll in Blue MedicareRx if you

permanently reside in Connecticut, Massachusetts, Rhode Island, or Vermont and are not

enrolled in another Medicare Part D prescription drug plan or a Medicare Advantage plan with

Part D coverage.

LINK TO NEXT STEP


Each year, Part D open enrollment begins on October 15 and ends on

December 7. It gives you the option to change your drug coverage for the

start of the New Year or enroll for the first time.

When you first become eligible for Medicare, you have a 7-month initial

enrollment period (IEP). If you don’t sign up in your IEP, you may have

to pay a late enrollment penalty every month for as long as you have a

Part D plan.

Reasons you become eligible for your IEP include:

• You are turning 65. You have 7 months to sign up: the 3 months before

your birthday, the month of your birthday, and the 3 months after your

birthday.

• You have a disability or end-stage renal disease. Your can sign up starting

in the 3 months before your disability or renal disease through the 3

months after your 25th month of disability.

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About Medicare Part D Choosing a Plan

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Coverage Stages

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Compare Plans

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Choosing a Plan Enrollment Eligibility

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Massachusetts Not Massachusetts?

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Need help? Contact Us1

Blue MedicareRx (PDP) is a Prescription Drug Plan with a Medicare Contract.

S2893_XXXX Page Last Updated XX/XX/2018.



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S2893_XXXX Page Last Updated XX/XX/2018.



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Explore how a Blue MedicareRx plan would work for you. Our prescription drug plans (PDPs) offer cover most Medicare-Eligible drugs through a large pharmacy network.

Comprehensive Drug CoverageEvery medication we cover is assigned to one of five drug tiers on our list of drugs, also known as a formulary. Drugs on lower tiers are mostly generics and will generally cost less than brand drugs found on higher tiers. Some drugs may require prior authorization or that you meet other special requirements before they are covered.

Nationwide Pharmacy Network With over 67,000 pharmacies, including large chains and independent pharmacies, you can travel anywhere in the United States and still have access to your medications. Choose from among our 36,000 preferred cost-sharing pharmacies or use our convenient mail service pharmacy to get the greatest cost savings.






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Explore how a Blue MedicareRx plan would work for you. Our prescription drug plans (PDPs) offer members comprehensive Medicare drug coverage through a large pharmacy network.


Home Coverage

Coverage of Most Medicare-Eligible Drugs


Easily find out what your medications may cost you with a Blue MedicareRx plan. No need to look through the formulary – simply enter your drugs in the Drug Pricing Tool. You will be able to not only confirm if the drugs are covered but also see your total estimated cost for both plans, including monthly premium and any deductibles.

More Options from Our Nationwide Network















Explore how a Blue MedicareRx plan would work for you. Our prescription drug plans (PDPs) offer cover most Medicare-Eligible drugs through a large pharmacy network.

Comprehensive Drug CoverageEvery medication we cover is assigned to one of five drug tiers on our list of drugs, also known as a formulary. Drugs on lower tiers are mostly generics and will generally cost less than brand drugs found on higher tiers. Some drugs may require prior authorization or that you meet other special requirements before they are covered.

Nationwide Pharmacy Network With over 67,000 pharmacies, including large chains and independent pharmacies, you can travel anywhere in the United States and still have access to your medications. Choose from among our 36,000 preferred cost-sharing pharmacies or use our convenient mail service pharmacy to get the greatest cost savings.







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With Blue MedicareRx (PDP), you can take advantage of the convenience of CVS Caremark Mail Service Pharmacy and have your drugs delivered directly to your door at any location in the U.S. You can save over 70% on Tier 1 drugs, and a 90-day supply of Tier 2 and 3 drugs will cost less than filling them at a retail pharmacy. Standard shipping is free.1










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Mail Service

Preferred Pharmacies

More than 36,000 pharmacy locations in our nationwide network offer preferred cost-sharing savings for Blue MedicareRx members. This means your out-of-pocket costs on prescriptions will be lower at these pharmacies than at standard cost-sharing pharmacies.






Locate the closest preferred cost-sharing pharmacy >



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Plan 1 Plan 2 Plan 3 (NEXT YEAR)

PLAN NAME

#########

#########Monthly Premium

Annual Deductible

To better understand your cost, visit the Drug Pricing Tool and enter all of your current medications to see an estimate of your total cost, including monthly premium, deductible and copays.

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Drug pricing tool

You can save over 70% on Tier 1 medications when you choose a preferred cost sharing pharmacy. Visit the Pharmacy Locator to find the closest Preferred Pharmacy to you. Pharmacy locator

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This directory is for a subset of network pharmacies identified which includes the area in which you live. However, we cover a larger service area, and there are more pharmacies where your prescriptions may be covered by our Plan. New Medicare regulations require all Part D plans to obtain patient consent before each delivery of new or refilled prescription. The typical number of days after the mail order pharmacy receives an order to receive your shipment is up to 10 days. Enrollees have the option to sign up for automated mail order delivery. If your mail order drugs do not arrive within the estimated time frames please Contact Us S2893_18146 Page Last Updated 09/30/2018. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities which have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal.


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About Part D What it is, how you get it, and if it might be for you. Verify if Medicare drug coverage is available to you.

Learn more

When to EnrollSign-up starts before you turn 65 or are first eligible for Medicare. Generally, there are three enrollment periods.

Learn more

Coverage StagesEvery plan has them. Medicare coverage stages affect the amount you pay for each covered medication.

Learn more

Part D CostsPer year vs per month? The total estimated cost for any plan can be broken into a few types of costs.

Learn more

Choosing a PlanHow to zero in on the plan for you. Weighing your options is easier when you know what to look for.

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Before getting into our plans and coverage, let’s take a look at the basics.

Whether you take many medications or

none at all, enrolling in Medicare

prescription drug coverage is voluntary

and it can help protect you from

unexpected high costs.

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Medicare Prescription Drug Coverage:

Start with the Basics

It’s important to understand how Medicare helps pay for medications and how it applies to

you. But we know it can be overwhelming. That’s why we are here to help you learn the

basics, before jumping into any decision-making.

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For all other combinations - You may want to consider Value Plus

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If 3 = Yes -You may want to consider Premier

For all other combinations - You may want to consider Value Plus

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