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What are the costs and benefits?

Medi-CareFirst offers two Part D plans, BlueRx Standard (PDP) and BlueRx Enhanced (PDP). Both plans are approved by Medicare, and offer the same basic benefits:

  • The same copayments/coinsurance for your prescription drugs.
  • A 90-day supply of maintenance medications for only two copays.
  • A 34-day supply for one month.

Additionally, BlueRx Enhanced (PDP) offers a lower copay for Generic drugs, coverage for all Generic drugs while members are in the coverage gap, and no annual deductible. The chart below compares the benefits of BlueRx Standard (PDP) and BlueRx Enhanced (PDP).


Your BlueRx (PDP) Plan Options
  BlueRx Standard (PDP) BlueRx Enhanced (PDP)
  You Pay In-Network*
Monthly Premium** $87.10 $131.80
Annual Deductible
(amount you must pay out-of-pocket before Medi-CareFirst pays its share) 		$150 $0

Initial Coverage Limit
(amount you and your plan pay In-Network for the first $2,930 in total drug costs for the calendar year)

For 34-day supply you pay:

  • $8 for Generic (Tier 1)
  • $30 for Preferred Brand (Tier 2)
  • $65 for Non-Preferred Brand (Tier 3)
  • 25% for Specialty Tier Drugs (Tier 4)

For 34-day supply you pay:

  • $8 for Generic (Tier 1)
  • $30 for Preferred Brand (Tier 2)
  • $65 for Non-Preferred Brand (Tier 3)
  • 25% for Specialty Tier Drugs (Tier 4)

For 90-day supply of maintenance drugs you pay:

  • $16 for Generic (Tier 1)
  • $60 for Preferred Brand (Tier 2)
  • $130 for Non-Preferred Brand (Tier 3)
  • 25% for Specialty Tier Drugs (Tier 4)

For 90-day supply of maintenance drugs you pay:

  • $16 for Generic (Tier 1)
  • $60 for Preferred Brand (Tier 2)
  • $130 for Non-Preferred Brand (Tier 3)
  • 25% for Specialty Tier Drugs (Tier 4)
Coverage Gap***
(amount you pay until your out-of-pocket expenses reach $4,700 for the calendar year)

For 34-day supply you pay:

  • Generic: 86%
  • Brand: Discounted price

For 34-day supply you pay:

  • Generic: $8
  • Brand: Discounted price

For 90-day**** supply of maintenance drugs you pay:

  • Generic: 86%
  • Brand: Discounted price

For 90-day**** supply of maintenance drugs you pay:

  • Generics: $16
  • Brand: Discounted price
Catastrophic Coverage
(amount you pay after your out-of-pocket expenses reach $4,700 for the calendar year)

You pay whichever is the greater cost:

  • $2.60 for Generic or Brand Drugs treated as Generics and $6.50 for all other covered drugs
  • OR 5% of the Drug's Cost (Generic or Brand)
NOTES:

* The copays listed above are for In-Network pharmacies. You must use In-Network pharmacies, except under emergency circumstances.

** If you missed your Initial Enrollment Period you will likely pay an additional 1% of the national average premium for each month that you did not have coverage that was at least as good as the Medicare Prescription Drug Program. You also must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party.

*** Members (those not already receiving "Extra Help") get discounts on most covered Part D brand-name drugs in the coverage gap. Discounts are based on agreements between the federal government and certain drug manufacturers. For this reason, most, but not all, brand-name drugs are discounted.

**** 90-day supply is for "maintenance medications" taken regularly for an ongoing condition such as high blood pressure or diabetes.

Additional Features

Both BlueRx (PDP) plans:

  • Accept prescriptions from any doctor, so you may see any doctor you wish.
  • Include a large regional network of over 1,400 pharmacies, as well as a national network of more than 64,000 pharmacies (including retail, home-infusion and long-term care pharmacies).
  • Offer a free, optional Medication Therapy Management Program to help members with several medical conditions choose drugs that work best together to treat those conditions.

Learn More

Review a complete list of plan benefits:


For more information:

  • Visit our Frequently Asked Questions section.
  • 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 75 percent or more of your 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.
  • You may be able to get Federal extra help to pay for your prescription drug premiums and costs. To see if you qualify, call:
    • 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week.
    • The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778. You can also visit the Social Security Web site.
    • Your local State Medicaid Office.
  • If you live in Maryland and think you might be eligible for extra help, please call the Senior Prescription Drug Assistance Program (SPDAP) at 1-800-551-5995 (TTY: 1-800-877-5156) from 8 a.m. - 5 p.m. EST, weekdays.
  • If you live in Delaware and think you might be eligible for extra help, please call the Delaware Prescription Drug Assistance or Delaware Chronic Renal Disease programs at 1-800-996-9969 (TTY: 800-232-5460). Select option 2, then option 1.

Note: The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact Medi-CareFirst.

Next, see if your drugs are covered.

Plan Resources

Additional Information

Senior Prescription Drug Assistance Program

We administer Maryland's SPDAP program

Find out what it is and if you're eligible.