Overview
Deductible
Tier 1 preferred generic drugs: $0
All other covered drugs: $255
Pharmacy copays
Copays start at $2 for Tier 1 generic drugs filled at a preferred network pharmacy. Certain drugs may cost more if you choose a pharmacy in our standard network.
Drug list
Plan features
• You can fill your prescriptions at more than 95 percent* of pharmacies in Michigan. Find a pharmacy.
• Mail-order and 90-day prescriptions are available.
• You're covered if you need to fill a prescription while traveling within the U.S.
Prescriptions
Pharmacy deductible
This plan has a $255 pharmacy deductible for Tiers 2-5. You pay full price for drugs before you meet the deductible, except for Tier 1, which has no deductible. You can save by going to a preferred pharmacy in our network. Check out the example of what you'll pay for a one-month supply at a preferred pharmacy compared with a standard pharmacy.
Initial coverage: Before costs reach $4,020
Tier 1: Preferred generic drugs
Commonly prescribed generic versions of brand medications. You’ll pay the least for these drugs at the pharmacy.
Preferred: $2
Standard: $8
Tier 2: Generic drugs
Although you’ll pay more at the pharmacy for these generic drugs, they're more cost-effective than brand medications.
Preferred: $11
Standard: $20
Tier 3: Preferred brand drugs
Brand drugs that aren’t available yet as a generic.
Preferred: $42
Standard: $47
Tier 4: Nonpreferred drugs
Because there are alternatives for the drugs in this tier, you’ll pay more for them at the pharmacy.
Preferred: 50% of the cost
Standard: 50% of the cost
Tier 5: Specialty drugs
Specialty drugs are used to treat complex conditions like cancer and multiple sclerosis. Although they can be generic or brand, they usually need special handling and approval. You may have to order them through a specialty pharmacy.
Preferred: 28% of the cost
Standard: 28% of the cost
Coverage gap: When costs are $4,020 - $6,350
Generic: 25% of the cost
Preferred: 25% of the cost
Catastrophic coverage: When costs are more than $6,350
Generic drugs: $3.60 copay or 5% of the cost, whichever is greater
Other drugs: $8.95 copay or 5% of the cost, whichever is greater
Forms and Documents
Learn more about this plan
This brochure explains our Medicare Part D plans so you can choose the best option for you.
• Pre-enrollment Brochure (PDF)
This booklet explains how to use this plan's benefits. It also lists some of the things this plan doesn't cover.
• Evidence of Coverage (PDF)
This document lists important features and rules for this plan. It also shows you the differences between benefits for Original Medicare, this plan and our other Prescription Blue PDP plans.
• Summary of Benefits (PDF)
Find your prescription
Find a pharmacy
Find a pharmacy in our network where you can fill your prescriptions.
• Find a pharmacy
Do you qualify for help?
Ready to enroll?
Prescription BlueSM PDP Preferred
