BlueMedicare Premier Rx (PDP)

Plan costs

Premium $158.90 monthly

Benefits

Pharmacy coverage
Prescription deductible$0
One-Month Supply (Retail Pharmacy) with Standard Cost Sharing
Preferred Generic$0 copay
Generic $5 copay
Preferred Brand$47 copay
Non-Preferred Drug34% coinsurance
Specialty Tier33% coinsurance
Insulin Products$35 copay for a one-month supply
100-Day Supply (Mail-Order Pharmacy) with Standard Cost Sharing
Preferred Generic$0 copay
Generic$15 copay
Preferred Brand$141 copay
Non-Preferred Drug34% coinsurance
Specialty TierNot covered
Insulin Products$70 copay for a two-month supply or $105 for a three-months supply (excluding Tier 5)

 

Plan Documents
Summary of BenefitsBlueMedicare Premier Rx (PDP) 2025 Summary of Benefits
Plan DocumentsBlueMedicare Premier Rx (PDP) Plan Documents

 

Preferences

Plan: S5795-002

Limitations, copayments, and restrictions may apply. See above or contact the plan for more details.

*Enrollee must continue to pay the Medicare Part B premium.

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:
  • 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048. 24 hours a day, 7 days a week.
  • The Social Security Office at 800-772-1213. TTY users should call 1-800-325-0778. Monday through Friday, 7:00 a.m. to 7:00 p.m.
  • Your State Medicaid Office.
Return to top