2013 RxBLUE Plus PDP Benefits

RxBLUE Plus PDP covers an open formulary of all Medicare Part D-approved prescription drugs and is accepted at a wide selection of pharmacies across Louisiana.

RxBLUE Plus PDP benefits go into effect January 1, 2013.

2013 Plan Benefit Outline 

2013 RxBLUE Plus PDP Diagram 

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

You have a $0 deductible and you pay $5 for generic drugs. A list of generics can be found in the RxBLUE PDP 2013 Formulary Guide.

If you choose a brand-name drug, you'll pay $35. For Specialty drugs, you'll pay 30 percent coinsurance, which means you pay 30 percent of the cost of the drug and Blue Cross pays 70 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 $5 Generic
Tier 2 $35 Preferred Brand
Tier 3 30% Coinsurance Specialty Drugs

Coverage Gap

After your costs and Blue Cross costs reach $2,970, you'll still have limited coverage on certain drugs in the "coverage gap." Your discounted brand-name drugs will generally cost you no more than 47.5% of the plan's cost. Generic drugs will cost you no more than $5. Once your yearly out-of-pocket drug costs reach $4,750, you will be eligible for catastrophic coverage.

Catastrophic coverage

RxBLUE PDP protects you financially from catastrophic prescription costs in the event of a serious medical condition. Once your out-of-pocket costs reach $4,750, you pay only 5% coinsurance or $2.65 for a generic drug and $6.60 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

2013 Premium Information

The RxBLUE Plus PDP premium for 2013 is $118.00 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 Plus PDP 2013 Benefits

To find out if RxBLUE Plus 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.

Limitations, copayments and restrictions may apply.

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2014.

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_MKT113012
CMS Approved
Page Last Updated: 12:30 p.m. on 03.28.2013