Arkansas BlueCross Blue Shield Medi-Pak Choice
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2012 Medi-Pak Rx (PDP)

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Your plan benefits coverage for what Medicare does not pay

Plan Benefits for Level 1
Monthly Premium
Formulary
Deductible
Generic drug copay
Preferred brand name drug copay
Non-preferred brand name drug copay
Gap Coverage for generic
Medi-Pak Rx
Basic
Medi-Pak Rx
Premier
$34.40 $90.80
Standard Enhanced
$255 $0
$6 $6
$45 $45
$84 $84
86% coinsurance $6 copay

More Information
Detailed Plan Benefits
Medi-Pak Rx Basic Rights and Benefits
Medi-Pak Rx Premier Rights and Benefits

As of 9/1/2011, our network includes 744 participating pharmacies in Arkansas.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact Arkansas Blue Cross and Blue Shield. This is an advertisement; for more information, contact a benefits specialist.