Basic Blue Rx 2018

Your choice for drug coverage in [state_name]

Prescription drugs can be expensive. Basic Blue Rx is a Part D Prescription Drug Plan designed to help you manage your drug costs. Even if you don’t have drug costs now, this plan can protect you from the expense of prescription drugs you may need in the future.

Basic Blue Rx offers you:

  • Protection from unexpected drug costs
  • Coverage of preferred and non-preferred generic and brand-name drugs, as well as specialty drugs
  • Access to a nationwide network of pharmacies that include major chains as well as neighborhood pharmacies. You can also search our drug list (formulary) to see if your medications are covered.

Plan Information

  • Check your drug costs using our cost estimator. Remember to compare all the benefits and value offered, in addition to out-of-pocket costs.
  • If you are new to Medicare, you may want to learn more about Medicare before choosing a plan.

Rates and coverage details

2018 Basic Blue Rx Plan Benefits & Premium - [state_name]
Monthly plan premium [premium]
Annual deductible $0 deductible on tiers 1 & 2; $405 deductible on tiers 3-5
Tiers Preferred cost sharing
After you pay the applicable deductible
Standard cost sharing
After you pay the applicable deductible
Tier 1: Preferred Generic drugs $4 $16
Tier 2: Generic drugs $9 $20
Tier 3: Preferred Brand drugs 15% 21%
Tier 4: Non-Preferred drugs 30% 46%
Tier 5: Specialty drugs 25% 25%
Refer to the  Summary of Benefits  for complete plan information.

Use our pharmacy network for the greatest benefits

Once enrolled in Basic Blue Rx, you’ll have access to a nationwide network of pharmacies that include major chains as well as neighborhood pharmacies. You may go to any of our network pharmacies. However, your costs may be even less for your covered drugs if you use a network pharmacy that offers preferred cost sharing rather than a pharmacy that offers standard cost sharing.

In most cases, your prescriptions are covered only if they are filled at one of our network pharmacies. If you go to a pharmacy that is not in our network, you may have to pay more for your prescriptions and you may have to file a claim to be reimbursed. You will pay any difference between the non-network pharmacy’s charge and the amount the plan allows. Some drugs may have  quantity limits or other restrictions that apply.


Once you join our plan

When you join Basic Blue Rx you may receive an occasional letter from the plan. For example, if you have other prescription drug coverage, you may receive a letter asking that you verify your other coverage so that Medicare can coordinate your benefits with your other plan coverage.

You will receive a letter from the plan shortly after your enrollment application is received if an agent helped with your enrollment. Its purpose is to make sure you are enrolled in the correct plan, describe how the plan works and answer any questions you may have.

If you have any questions about letter or phone call you receive from the plan, please call 1-877-376-2185 (TTY hearing impaired users call 711).

Medication Therapy Management (MTM) Program

If you meet certain requirements, you may be invited to participate in a program designed for your specific health and pharmacy needs. You may choose not to participate, but it is recommended that you take full advantage of this service if you are selected. Find out more about the program including who is eligible for MTM.