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HealthyBlue Your BlueMedicare plan rewards Not Available <br />Rewards you for taking care of your <br />health. Redeem gift card rewards <br />for completing and reporting <br />preventive care and screenings. <br />Part D Prescription Drug Benefits <br />Deductible Stage <br />This plan does not have a prescription drug deductible. <br />Initial Coverage Stage <br />You begin in this stage when you fill your first prescription of the year. <br />During this stage, the plan pays its share of the cost of your drugs, and you pay your share of the cost <br />(your copayment or coinsurance amount). You remain in this stage until your total yearly costs reach <br />$7,400. When you reach the out-of-pocket limit of $7,400, you leave the Initial Coverage Stage and <br />move on to the Catastrophic Coverage Stage. <br />You may get your drugs at network retail pharmacies and mail order pharmacies. Our plan gives you <br />preferred pharmacy options. You can fill your prescription drugs at one of our preferred pharmacies <br />to save even more on most prescriptions. <br />Coverage Gap Stage <br />Because there is no coverage gap for this plan, this payment stage does not apply to you. <br />During the Coverage Gap Stage: <br />13 339 <br />Preferred <br />Standard Retail <br />Mail Order <br />Retail/LTC <br />(31 -day <br />(90 -day <br />(31 -day <br />supply) <br />supply) <br />supply) <br />Tier 1 - Preferred Generic <br />$3 copay <br />$10 copay <br />$0 copay <br />Tier 2 - Generic <br />$8 copay <br />$15 copay <br />$8 copay <br />Tier 3 - Preferred Brand <br />$35 copay <br />$40 copay <br />$70 copay <br />Tier 4 -Non-Preferred <br />$65 copay <br />$85 copay <br />$195 copay <br />Drug <br />Tier 5 - Specialty Tier <br />33% of the cost <br />33% of the cost <br />N/A <br />Coverage Gap Stage <br />Because there is no coverage gap for this plan, this payment stage does not apply to you. <br />During the Coverage Gap Stage: <br />13 339 <br />