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Blue Medicare HMO Blue Medicare PPO

Provider resources and information

Drug tiers

Drugs are assigned into three payment categories, based on usage, cost and clinical effectiveness.

Enhanced plans (HMO and PPO)

Tier 1 – Generic drugs

  • Generic medications
  • Lowest copayment

Tier 2 – Brand–name drugs

  • Brand–name medications
  • Second lowest copayment

Tier 3 – Specialty drugs

  • Generic and brand agents classified by Blue Medicare HMO and Blue Medicare PPO as specialty drugs
  • Typically prescribed by a specialist
  • Have unique uses, or may require special dosing or administration
  • Generally more costly than other drugs
  • Members pay a coinsurance amount for these medications

Standard plans (HMO and PPO)

Tier 1 – Generic drugs

  • Generic medications
  • Member pays the applicable coinsurance amount
  • Typically less expensive than brand name drugs

Tier 2 – Brand–name drugs

  • Brand–name medications
  • Member pays the applicable coinsurance amount
  • Typically more expensive than generic drugs

Tier 3 – Specialty drugs

  • Generic and brand agents classified by Blue Medicare HMO and Blue Medicare PPO as specialty drugs
  • Typically prescribed by a specialist
  • Have unique uses, or may require special dosing or administration
  • Generally more costly than other drugs
  • Members pay a coinsurance amount for these medications

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Blue Medicare HMO and Blue Medicare PPO plans are offered by PARTNERS National Health Plans of North Carolina, Inc., a subsidiary of Blue Cross and Blue Shield of North Carolina (BCBSNC). PARTNERS is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. Plans are administered by BCBSNC. BCBSNC and PARTNERS do not discriminate based on color, gender, religion, national origin, age, race, disability, handicap, sexual orientation, genetic information, source of payment or health status as defined by the Centers for Medicare & Medicaid Services (CMS). All qualified Medicare beneficiaries may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in the CMS-approved service area. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or another third party. BCBSNC and PARTNERS are independent licensees of the Blue Cross and Blue Shield Association.

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