Prescription Drug Benefits for Medicare Retirees

Highlights

Your Medicare Part D prescription drug benefits are provided through Group MedicareBlue℠ Rx (PDP), a prescription drug plan with a Medicare contract.

You pay the amounts below for covered Part D prescription drugs until your out-of-pocket costs reach $2,100. Then, the plan pays the full cost for your covered Part D drugs for the rest of the calendar year.

To utilize your prescription benefits, you must show your Group MedicareBlue Rx ID card each time you visit the pharmacy.

30-Day Supply

90-Day Supply

Tier 1 (Generic or Preferred Generic)

Tier 2 (Preferred Brand)

Tier 3 (Non-Preferred Drug)

Tier 4 (Specialty)

Tier 1 (Generic or Preferred Generic)

Tier 2 (Preferred Brand)

Tier 3 (Non-Preferred Drug)

Tier 4 (Specialty)

Standard Retail Pharmacy or Standard Mail Order

You pay 20%

You pay 25%

You pay 20%

You pay 25%

Vaccines

Knowing how your coverage works can save you from paying out of pocket for your vaccines. The Medicare Part D portion of your plan covers all commercially available vaccines—except those covered by Part B—as long as the vaccine is reasonable and necessary to prevent illness.

This means that there are some vaccines, such as shingles, Tdap, and hepatitis A, that you should get at your pharmacy. If you get them from your doctor, you will have to pay the full cost of the vaccine out of pocket.

Details

Group MedicareBlue Rx Plan Copay Summary
Group MedicareBlue Rx Summary of Benefits
Pre-enrollment call center: 1-888-299-5233
Post-enrollment Group MedicareBlue Rx Customer Service: 1-877-838-3827
Group MedicareBlue Rx member website

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