Blue Cross MedicareRx Value (PDP) is a Medicare Prescription Drug Plan by Blue Cross and Blue Shield of New Mexico.
This page features plan details for 2022 Blue Cross MedicareRx Value (PDP) S5715 – 003.
Blue Cross MedicareRx Value (PDP) is offered in the following locations.
Blue Cross MedicareRx Value (PDP) offers the following coverage and cost-sharing.
| Insurer: | Blue Cross and Blue Shield of New Mexico |
| Drugs Covered: | Yes |
Ready to sign up for Blue Cross MedicareRx Value (PDP) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $0.00 | $ | $88.50 | $0.00 | $ |
Blue Cross MedicareRx Value (PDP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $480.00 |
| Initial Coverage Limit: | $4,430.00 |
| Catastrophic Coverage Limit: | $7,050.00 |
| Drug Benefit Type: | Enhanced |
| Gap Coverage: | Yes |
| Formulary Link: | Formulary Link |
| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $88.50 | $79.9 | $71.3 | $62.8 | $54.20 |
After you pay your $480.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00. Once you reach that amount, you will enter the next coverage phase.
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $1.00 copay | $10.00 copay | $1.00 copay | $10.00 copay |
| 2 (Generic) | $5.00 copay | $20.00 copay | $5.00 copay | $20.00 copay |
| 3 (Preferred Brand) | $45.00 copay | $47.00 copay | $45.00 copay | $47.00 copay |
| 4 (Non-Preferred Drug) | 42% | 45% | 42% | 45% |
| 5 (Specialty Tier) | 25% | 25% | 25% | 25% |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | ||||
| 2 (Generic) | ||||
| 3 (Preferred Brand) | ||||
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $3.00 copay | $30.00 copay | $3.00 copay | $30.00 copay |
| 2 (Generic) | $15.00 copay | $60.00 copay | $15.00 copay | $60.00 copay |
| 3 (Preferred Brand) | $135.00 copay | $141.00 copay | $135.00 copay | $141.00 copay |
| 4 (Non-Preferred Drug) | 42% | 45% | 42% | 45% |
| 5 (Specialty Tier) |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $1.00 copay | $10.00 copay | $1.00 copay | $10.00 copay |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $3.00 copay | $30.00 copay | $3.00 copay | $30.00 copay |
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | $3.95 copay or 5% (whichever costs more) |
| Brand-name drugs | $9.85 copay or 5% (whichever costs more) |
Ready to sign up for Blue Cross MedicareRx Value (PDP) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST