Prescription Drug Benefits

Gold and Platinum plan options include the same prescription drug benefits; use the expanded formulary and the same pharmacy network.

Their formulary includes drugs in all classes covered by Medicare Part D. The expanded formulary covers more drugs than the standard formulary.

To see if your drugs are covered and the copays that apply, please see our formulary (drug list).

Benefits

Gold & Platinum  

You Pay:

Deductible

$0

Amount you pay for a 30-day supply at a retail pharmacy*

Preferred Generics (Tier 1)

$2

Non-Preferred Generics (Tier 2)

$10

Preferred Brand (Tier 3)

$30

Non-Preferred Brand (Tier 4)

$55

Specialty (Tier 5)

33%

Amount you pay for a 90-day supply at a mail order pharmacy*

Preferred Generics (Tier 1)

$5

Non-Preferred Generics (Tier 2)

$25

Preferred Brand (Tier 3)

$75

Non-Preferred Brand (Tier 4)

$137.50

Specialty (Tier 5)

33%

Coverage Gap

No coverage in the gap. You pay 100%. You will receive discounts when you use network pharmacies.

Catastrophic Coverage (Begins when your annual out-of-pocket costs exceed $4,550)

You pay the greater of $2.50 for generics, $6.30 for all other drugs, or 5% coinsurance.

Formulary (Drug list)

Expanded

*You pay this amount until you and the plan pay a total of $2,830 for covered prescription drug expenses (including drug costs, copayments, coinsurance, and deductibles).

Please note: After your total yearly drug costs reach $2,830 you pay 100% of your drug costs until your yearly out-of-pocket drug costs reach $4,550.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7days a week;
  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
  • Your State Medicaid Office.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for seventy-five percent of drug costs including monthly  prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

For full information on BlueCross BlueShield of Tennessee benefits, call our Customer Service Department at 1-866-210-1522, 8 am to 9 pm, Eastern Time, 7 days a week. TTY users should call, 1-877-664-6422. From March 1 to September 30, you may be required to leave a voice mail on weekends and holidays. Calls will be returned within one business day.


 
 

BlueAdvantage PFFS

 

Other Resources

 

A health plan with a Medicare contract.
H5884_W10_R2 CMS Approved 01042010

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