Prescription Drug Benefits for Medicare Retirees

Highlights

Your prescription drug benefits are provided through the Group MedicareBlue Rx PDP.

You pay the amounts below for your prescription drugs until your drug costs reach the out-of-pocket maximum of $1,000. Afterwards, the plan pays 100% of your total drug costs.

To fully utilize your prescription benefits, you must show your Blue Cross Blue Shield 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%

N/A

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

Visit bluecrossmn.com/GroupSupplement.
Call MedicareBlue Rx at 1-877-838-3827.

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