BlueCross BlueShield of North Carolina

Blue Medicare RxSM (PDP)
Blue Medicare Rx is available in all 100 counties.

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If you're looking for 2015 plans, visit our 2015 Plans page. Plans listed are not available in all areas.

Sometimes referred to as Medicare Part D, Blue Medicare Rx (PDP) provides prescription drug coverage for those with Medicare.

Here's what Blue Medicare Rx (PDP) offers:

  • Over 1,800 prescription drugs covered in our Blue Medicare Rx (PDP) Enhanced plan
  • Uses a pharmacy network that includes most national chains, and includes mail order pharmacy services
  • Additional savings with our Preferred Pharmacy Network
  • Make prescriptions refills easy — get your prescriptions mailed to you, when you use mail order pharmacy services
  • An Enhanced plan that has no deductible and includes gap coverage when you buy preferred generic drugs

There are two Blue Medicare Rx (PDP) plans: Standard and Enhanced. Compare these with our side-by-side comparison.

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Important Legal Information and Disclaimers

U9406, 10/14

The information on this page is current as of 10/01/2014.

Y0079_ 6741 CMS pending

Compare Plans

Blue Medicare Rx (PDP) Standard meets Medicare's standard benefit requirements:

  • Monthly member premium for Standard: $41.001
  • $145 annual deductible
  • $4 and $40 copayments for most drugs when using our preferred network
  • A broad range of drugs (more than 1,000 — see our list)
  • Uses a pharmacy network that includes most national chains, and includes mail order pharmacy services2

Blue Medicare Rx (PDP) Enhanced exceeds Medicare benefit requirements:

  • Monthly member premium for Enhanced: $78.601
  • No deductible
  • $3 and $30 copayments for most drugs
  • An extensive list of covered drugs (more than 1,800 — see our list)
  • Uses a pharmacy network that includes most national chains, and includes mail order pharmacy services2
  • Make prescriptions refills easy — get your prescriptions mailed to you, when you use mail order pharmacy services
  • Our most popular plan3

The drug list (or formulary) includes generic, brand-name and specialty drugs covered by Blue Medicare Rx (PDP).4 Some drugs aren't covered, such as those excluded by law (over-the-counter medications and prescription vitamins, for example).

How much will your prescription drugs cost you? Here's what you could expect to pay for a 30-day prescription supply, depending on where you to to purchase your prescription drugs:

Preferred Retail Pharmacy
(CVS, Walmart, Kerr & Epic)
Non-Preferred Retail Pharmacy Preferred Mail Order Service
Drug List Tier Standard Rx Enhanced Rx Standard Rx Enhanced Rx Standard Rx Enhanced Rx
Tier 1 - Preferred Generic Drugs $4 $3 $10 $8 $4 $3
Tier 2 - Non-Preferred Generic Drugs $10 $6 $33 $20 $10 $6
Tier 3 - Preferred Brand-Name Drugs $40 $30 $45 $45 $40 $30
Tier 4 - Non-Preferred Brand-Name Drugs $85 $70 $95 $95 $85 $70
Tier 5 - Specialty Drugs 29% 33% 29% 33% 29% 33%

You pay the copayment per 30-day supply or coinsurance until your drugs, and the plan pays the remainder until the total drug costs reach $2850.

After your total yearly drug costs reach $2850, you have reached the Coverage Gap: you receive limited coverage on certain drugs and pay the following:

Preferred Retail Pharmacy
(CVS, Walmart, Kerr & Epic)
Non-Preferred Retail Pharmacy Preferred Mail Order Service
Standard Rx Enhanced Rx Standard Rx Enhanced Rx Standard Rx Enhanced Rx
Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs For Tier 1, preferred generics, you pay $3. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs. Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs For Tier 1, preferred generics, you pay $8. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs. Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs For Tier 1, preferred generics, you pay $3. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs.

After you reach $4550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 for brand-name or 5% of the total drug costs.

How much will your prescription drugs cost you? Here's what you could expect to pay for a 30-day prescription supply, depending on where you to to purchase your prescription drugs:

Preferred Retail Pharmacy
(CVS, Walmart, Kerr & Epic)
Standard Rx Enhanced Rx
Tier 1 - Preferred Generic Drugs $4 $3
Tier 2 - Non-Preferred Generic Drugs $10 $6
Tier 3 - Preferred Brand-Name Drugs $40 $30
Tier 4 - Non-Preferred Brand-Name Drugs $85 $70
Tier 5 - Specialty Drugs 29% 33%
Non-Preferred Retail Pharmacy
Standard Rx Enhanced Rx
Tier 1 - Preferred Generic Drugs $10 $8
Tier 2 - Non-Preferred Generic Drugs $33 $20
Tier 3 - Preferred Brand-Name Drugs $45 $45
Tier 4 - Non-Preferred Brand-Name Drugs $95 $95
Tier 5 - Specialty Drugs 29% 33%
Preferred Mail Order Service
Standard Rx Enhanced Rx
Tier 1 - Preferred Generic Drugs $4 $3
Tier 2 - Non-Preferred Generic Drugs $10 $6
Tier 3 - Preferred Brand-Name Drugs $40 $30
Tier 4 - Non-Preferred Brand-Name Drugs $85 $70
Tier 5 - Specialty Drugs 29% 33%

You pay the copayment per 30-day supply or coinsurance until your drugs, and the plan pays the remainder until the total drug costs reach $2850.

After your total yearly drug costs reach $2850, you have reached the Coverage Gap: you receive limited coverage on certain drugs and pay the following:

Preferred Retail Pharmacy
(CVS, Walmart, Kerr & Epic)
Standard Rx Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs
Enhanced Rx For Tier 1, preferred generics, you pay $3. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs.
Non-Preferred Retail Pharmacy
Standard Rx Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs
Enhanced Rx For Tier 1, preferred generics, you pay $8. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs.
Preferred Mail Order Service
HMO Standard Generally pay up to 72% for generic drugs and generally no more than 47.5% for brand drugs
Enhanced Rx For Tier 1, preferred generics, you pay $3. For all other generics, you generally pay up to 72% and generally no more than 47.5% for brand drugs.

After you reach $4550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 fir brand-name or 5% of the total drug costs.

We give you three ways to find out if your drugs are covered by our drug list (also known as a formulary):

  1. Use our online drug search.
  2. Call or visit your local agent (also known as an authorized sales representative).
  3. Call us at 1-800-478-0583, 7 days a week, 8 a.m. - 8 p.m. TTY/TDD users, call 1-800-922-3140.

If you'd like to see an in-depth explanation of Blue Medicare Rx (PDP) benefits, along with a list of exclusions and limitations, the product brochure has those details.

Getting Extra Help to Pay for Prescription Drugs

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

  • 1-800-MEDICARE (1-800-633-4227), 7 days a week, 24 hours a day. TTY users, call 1-877-486-2048
  • Social Security at 1-800-772-1213, Monday - Friday, 7 a.m. - 7 p.m. TTY users, call call 1-800-325-0778
  • Your state Medicaid office

People with limited incomes may qualify for extra help to pay for their prescription drug costs.

If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles and coinsurance. Additionally, those who qualify won't be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it.

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  1. You must continue to pay your Medicare Part B premium in addition to your plan premium.
  2. Beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.
  3. BCBSNC internal data, 2013.
  4. Formulary applies for all plans that include Medicare prescription drug coverage.

Important Legal Information and Disclaimers

U9406a, 10/14

The information on this page is current as of 10/01/2014.

Y0079_ 6741 CMS pending

To be eligible for Blue Medicare Part D, you must be:

  1. Entitled to Medicare Part A or enrolled in Medicare Part B.
  2. A North Carolina resident.

Annual enrollment period (AEP): October 15 through December 7 of every year.

Annual disenrollment period: January 1 through February 14 of every year.

Special Enrollment Periods

There are some limited situations where you could change outside of the October 15 - December 7 period. For example, if you moved out of your plan's service area, you'd have the chance to pick another plan based on your new location. Contact us for more information about this and other situations that qualify.

Delayed Enrollment

If you didn't enroll in Part D Medicare coverage when you were first eligible, you may enroll during the AEP each year thereafter. However, you may have to pay a late enrollment penalty premium.

Give us a call at 1-800-665-8037, 7 days a week, 8 a.m.-8 p.m. to learn more. TTY/TDD users, call 1-800-922-3140.

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Important Legal Information and Disclaimers

U9406b, 10/14

The information on this page is current as of 10/01/2014.

Y0079_ 6741 CMS pending

You have two choices when it comes to enrolling in a Blue Medicare Rx (PDP) plan: online application or paper application. But before you pick how you enroll, you should first:

  • Find out which drug plans are available in your area
  • Look at the plan's benefits and costs
  • Make sure your prescription drugs are covered on our drug list

Enroll Online

It's safe, easy and takes only minutes to enroll.

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Enroll by Paper

BCBSNC Enrollment P.O. Box 17168
Winston-Salem, NC 27116

If you'd rather request the enrollment form over the phone, or if you have enrollment questions, call us at 1-800-478-0583, seven days a week, 8 a.m. - 8 p.m. TTY/TDD users, call 1-800-922-3140.

We'll mail you an enrollment kit that includes the enrollment form, a Summary of Benefits document and additional plan information.

Changing Medicare Part D Plans

You can only be enrolled in one Part D plan at a time. If you enroll in a stand-alone Part D plan while enrolled in a Medicare Advantage (Part C) plan, federal law requires that you be disenrolled from the Part C plan and enrolled in Original Medicare (Parts A and B). Many Part C plans include prescription drug coverage, so make sure you check before considering a stand-alone Part D plan.

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Additional Links for Blue Medicare Rx (PDP)

Other Enrollment Options

You can also enroll in Blue Medicare Rx (PDP) Standard or Blue Medicare Rx (PDP) Enhanced through the CMS Medicare Online Enrollment Center.

Important Legal Information and Disclaimers

U9406c, 10/14

The information on this page is current as of 10/01/2014.

Y0079_ 6741 CMS pending