Prescription Blue PDP Plan Documents | Members

Plan details and benefits

Summary of Benefits (PDF)

Read about the benefits that come with your Prescription Blue PDP plan.
Evidence of Coverage (PDF)

This document lists important features and rules for this plan.
Pharmacy Directory (PDF)

This booklet lists which pharmacies are in this plan's network.
Drug List (PDF)

Learn which drugs are covered by this plan type and other details, like quantity limits and drug tiers.
Drug List Updates (PDF)

See if any drug coverage changes have been made for this plan.
Drug Prior Authorization and Step Therapy List (PDF)

See which medications require prior authorization or step therapy for this plan.
Low Income Subsidy Table (PDF)

Learn what your monthly premium might be if you qualify for Extra Help from Medicare.
Star Rating (PDF)

Medicare rates plans based on quality and performance every year with a system called Medicare Star Ratings.

Find the form you need to submit a claims reimbursement, coverage determination and more.

You'll see your plan's benefits, cost estimates and other details.