2012 RxBLUE Basic PDP Benefits

RxBLUE Basic PDP covers a basic formulary of commonly used Medicare Part D prescription drugs and is accepted at a wide selection of pharmacies across Louisiana.

RxBLUE Basic PDP benefits go into effect January 1, 2012.

2012 Plan Benefit Outline 

2012 RxBlue Basic PDP Benefits 

Benefits Description

Your plan coverage will change as you incur more costs. There are three stages of coverage as mandated by Medicare: Initial, Gap and Catastrophic. All Prescription Drug Plans are required to follow this pattern of coverage.

Initial Coverage

After you meet a $320 deductible, you pay $3 for generic drugs. A list of generics can be found in the RxBLUE Basic PDP 2012 Formulary Guide.

If you choose a brand-name drug, you'll pay $46. For Specialty drugs, you'll pay 25 percent coinsurance, which means you pay 25 percent of the cost of the drug and Blue Cross pays 75 percent.

Your Initial Coverage Costs

The amount you pay for each drug will depend on the drug type or tier.
Tier You Pay Type of Drug 

Tier 1 $3 Generic
Tier 2 $46 Brand
Tier 3 25% Coinsurance Specialty Drugs

Coverage Gap

Once your costs and Blue Cross costs combined reach $2,930, you'll receive discounts on brand-name drugs and pay 86 percent of the plan's cost for generic drugs until your out-of-pocket costs reach $4,700. This is often referred to as the "coverage gap." But each time you use your member ID card at a network pharmacy, you'll have access to Blue Cross discounts at the point of purchase.

Catastrophic coverage

RxBLUE Basic PDP protects you financially from catastrophic prescription costs in the event of a serious medical condition. Once your out-of-pocket costs reach $4,700, you pay only 5 percent coinsurance or $2.60 for a generic drug and $6.50 for all other drugs – whichever is greater. Blue Cross pays the rest.

This level of coverage lasts until the end of your plan year.

Please note: If you believe you have already qualified for low income subsidy and believe you are paying an incorrect copayment amount, Medicare has established a process that will allow you to provide evidence of your proper copayment level. Learn more

2012 Premium Information

The RxBLUE Basic PDP premium for 2012 is $38.20 per month. Lower premiums and coinsurance payments are available for those who have qualified for Extra Help.

You must continue to pay your Medicare Part B premium if it is not otherwise paid for under Medicaid or another third-party.

Learn more about RxBLUE Basic PDP 2012 Benefits

To find out if RxBLUE Basic PDP is right for you, request more information or view the documents below.

Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company, a Medicare-approved Part D sponsor.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan.

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2013.

You must continue to pay your Medicare Part B premium.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
  • Your State Medicaid Office.

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 seventy-five (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. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048. Limitations, copayments and restrictions may apply.

You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances.

S5937_MKT110411
CMS Approved 12132011
Page Last Updated: 11:00 a.m. on 12.05.2012