How a 4-Tier Drug Plan Works

How a 4-Teir Drug Plan Works

For pricing, drugs are divided into the following four tiers. For a 34-day supply you pay:

	Blue Rx Standard Plan	Blue Rx Enhanced Plan
Tier 1 (Generic)	$9	$9
Tier 2 (Preferred Brand-Name)	$28	$28
Tier 3 (Non-Preferred Brand-Name)	$66	$66
Tier 4 (Non-Self Administered Medical Injectables)	25% of the drug's cost	25% of the drug's cost

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Medigap policies offered in Maryland's counties except Prince George's and Montgomery Counties are issued by CareFirst of Maryland, Inc.; Medigap policies offered in Maryland's Prince George's and Montgomery Counties, Washington, D.C. and Virginia are issued by Group Hospitalization and Medical Services, Inc.

Serving Maryland, Delaware, the District of Columbia and portions of Virginia. Medi-CareFirst BlueCross BlueShield is the business name of First Care, Inc. and Group Hospitalization and Medical Services Inc., and each is an independent licensee of the Blue Cross and Blue Shield Association.
® Registered trademark of the Blue Cross and Blue Shield Association. ®' Registered trademark of CareFirst of Maryland, Inc.

Medi-CareFirst BlueCross BlueShield is a Medicare approved Part D sponsor.

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