Medicare Prescription Drug Plans


Print


Blue Cross MedicareRxSM offers three plan designs:

  • Basic
  • Value
  • Plus


Protect yourself from some of the costs that Original Medicare doesn't cover by adding Blue Cross MedicareRx to your coverage.


Blue Cross MedicareRx offers:

  • Fixed copayments and coinsurances
  • Comprehensive drug lists
  • Convenience of nationwide coverage at thousands of pharmacies
  • Mail-order choices
  • Savings on copays when Preferred Pharmacies are used



Select a plan name below to view 2015 plan information or shop for a 2014 plan .

OK Medicare Tables
Basic Value Plus
2015 Blue Cross MedicareRx Plans
Blue Cross MedicareRx Basic (PDP)
Monthly Premium
$28.10
Annual Prescription Deductible*
$320 (All Tiers)
Copays and Coinsurances
Preferred Pharmacy
Standard
Tier 1 - Preferred Generic Drugs
$1 copay
$6 copay
Tier 2 - Non-Preferred Generic Drugs
$6 copay
$11 copay
Tier 3 - Preferred Brand Drugs
$39 copay
$45 copay
Tier 4 - Non-Preferred Brand Drugs
$90 copay
$95 copay
Tier 5 - Specialty Drugs
25% of the cost
25% of the cost
Gap Coverage
You will pay 45% of the plan's cost for covered Brand Name Drugs and 65% of the plan's cost for Generic Drugs until your yearly out-of-pocket drug costs reach $4,700.
After the Gap Copays
After your yearly out-of-pocket drug costs (including drugs purchased through retail pharmacy and mail-order) reach $4,700, you will pay the greater of:

Tiers 1 & 2 - $2.65 copay or 5% coinsurance for your drug
Tiers 3 & 4 - $6.60 copay or 5% coinsurance for your drug
Tier 5 - 5% coinsurance for your drug
Annual Notice of Change
Evidence of Coverage
Summary of Benefits

2015 Blue Cross MedicareRx Plans
Blue Cross MedicareRx Value (PDP)
Monthly Premium
$54.80
Annual Prescription Deductible*
$275 (Tiers 3 -5)
Copays and Coinsurances
Preferred Pharmacy
Standard
Tier 1 - Preferred Generic Drugs
$0 copay
$5 copay
Tier 2 - Non-Preferred Generic Drugs
$6 copay
$11 copay
Tier 3 - Preferred Brand Drugs
$37 copay
$42 copay
Tier 4 - Non-Preferred Brand Drugs
$85 copay
$95 copay
Tier 5 - Specialty Drugs
25% of the cost
25% of the cost
Gap Coverage
You will pay 45% of the plan's cost for covered Brand Name Drugs and 65% of the plan's cost for Generic Drugs until your yearly out-of-pocket drug costs reach $4,700.
After the Gap Copays
After your yearly out-of-pocket drug costs (including drugs purchased through retail pharmacy and mail-order) reach $4,700, you will pay the greater of:

Tiers 1 & 2 - $2.65 copay or 5% coinsurance for your drug
Tiers 3 & 4 - $6.60 copay or 5% coinsurance for your drug
Tier 5 - 5% coinsurance for your drug
Annual Notice of Change
Evidence of Coverage
Summary of Benefits

2015 Blue Cross MedicareRx Plans
Blue Cross MedicareRx Plus (PDP)
Monthly Premium
$120.90
Annual Prescription Deductible*
$0
Copays and Coinsurances
Preferred Pharmacy
Standard
Tier 1 - Preferred Generic Drugs
$0 copay
$5 copay
Tier 2 - Non-Preferred Generic Drugs
$2 copay
$7 copay
Tier 3 - Preferred Brand Drugs
$33 copay
$40 copay
Tier 4 - Non-Preferred Brand Drugs
$80 copay
$95 copay
Tier 5 - Specialty Drugs
33% of the cost
33% of the cost
Gap Coverage
You will pay $0/$5 for drugs in Tier 1 and $2/$7 for drugs in Tier 2. You will receive coverage for many generics and some brands on Tiers 3, 4 and 5 or pay 45% of the cost of Brand Name drugs and 65% of the cost of Generic drugs.
After the Gap Copays
After your yearly out-of-pocket drug costs (including drugs purchased through retail pharmacy and mail-order) reach $4,700, you will pay the greater of:

Tiers 1 & 2 - $2.65 copay or 5% coinsurance for your drug
Tiers 3 & 4 - $6.60 copay or 5% coinsurance for your drug
Tier 5 - 5% coinsurance for your drug
Annual Notice of Change
Evidence of Coverage
Summary of Benefits


 



Thank you for looking at coverage options for Blue Cross MedicareRx
We Can Help!

Call 1-866-267-9988 TTY/TDD 711
for personal help finding a plan.


We are open 8 a.m. – 8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on weekends and holidays.

To verify your recent enrollment, check the status of a claim or ask questions about your existing coverage, please contact Customer Service at: 1-888-285-2249 TTY/TDD 711

No thanks, I'm still looking