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January 2013
Medicare Advantage Part D benefits change for 2013
The following Medicare Part D changes for Blue Cross Blue Shield of Michigan Medicare Advantage members are effective Jan. 1, 2013.
Prescription drug tier coverage
The following tiers have changed designations:
- Tier 1: Preferred generic drugs
- Tier 2: Nonpreferred generic drugs
- Tier 3: Preferred brand drugs
- Tier 4: Nonpreferred brand drugs
All specialty drugs remain in Tier 5. Non-self-administered injectable drugs are available in Tiers 1, 2, 3 and 4.
Initial coverage limit charge
The initial coverage limit has decreased from $2,930 to $2,800 for Prescription Blue PDPSM Option A. The initial coverage limit for Prescription Blue PDP Option B, Vitality, Signature and Assure is now $2,970.
Deductible change
Medicare Advantage Part D Essential and Vitality plans have a $325 standard Medicare deductible. PDP Option A has a $125 deductible for Tiers 3, 4 and 5.
Coverage gap discount increase
In 2012, members in the coverage gap paid 86 percent of the price (plus the dispensing fee) of generic drugs. In 2013, members will be responsible for 79 percent of these prescription drug costs. In 2012, members in the coverage gap paid 50 percent of the price (plus the dispensing fee) of brand drugs. In 2013, members will be responsible for 47.5 percent of these prescription drug costs.
Out-of-pocket threshold change
The out-of-pocket maximum for BCBSM Medicare Advantage members has increased from $4,700 to $4,750.
Catastrophic coverage limit change
The catastrophic portion after the coverage gap will require members to pay the greater amount of a $2.65 copayment for generic drugs (including brand drugs treated as generic), a $6.60 copay for all other drugs or 5 percent coinsurance.
For more information, contact your provider consultant.
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