2027 Medicare Part D prescription drug plan
HealthSpringSM Assurance Rx (PDP): 2027 benefits and costs
Blue Cross and Blue Shield of IL, NM, OK, TX PDP
CMS plan ID: S5715-036-0 · Plan year: 2027
HealthSpringSM Assurance Rx (PDP) is a 2027 Medicare Part D prescription drug plan offered by Blue Cross and Blue Shield of IL, NM, OK, TX. It is listed in Indiana, Kentucky.
2027 plan costs at a glance
- Organization
- Blue Cross and Blue Shield of IL, NM, OK, TX
- Plan organization
- MEDCO CONTAINMENT LIFE & MEDCO CONTAINMENT NY & HEALTH CARE SERVICE CORPORATION
- Parent company
- Health Care Service Corporation
- Plan type
- PDP
- Part D premium
- $122.40
- 2027 CMS Star Rating
2027 benefit summary
Prescription drug coverage
Costs shown are for initial coverage.
Preferred retail costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 90 days |
|---|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 | $0.00 |
| Tier 2Generic | $3.00 | $6.00 | $9.00 |
| Tier 3Preferred Brand | 22% | 22% | 22% |
| Tier 4Non-Preferred Drug | 32% | 32% | 32% |
| Tier 5Specialty Tier | 25% | Not listed | Not listed |
Standard retail costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 90 days |
|---|---|---|---|
| Tier 1Preferred Generic | $4.00 | $8.00 | $12.00 |
| Tier 2Generic | $12.00 | $24.00 | $36.00 |
| Tier 3Preferred Brand | 22% | 22% | 22% |
| Tier 4Non-Preferred Drug | 32% | 32% | 32% |
| Tier 5Specialty Tier | 25% | Not listed | Not listed |
Mail-order and other pharmacies
Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.
Preferred mail order costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 90 days |
|---|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 | $0.00 |
| Tier 2Generic | $3.00 | $6.00 | $9.00 |
| Tier 3Preferred Brand | 22% | 22% | 22% |
| Tier 4Non-Preferred Drug | 32% | 32% | 32% |
| Tier 5Specialty Tier | 25% | Not listed | Not listed |
Standard mail order costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 90 days |
|---|---|---|---|
| Tier 1Preferred Generic | $4.00 | $8.00 | $12.00 |
| Tier 2Generic | $12.00 | $24.00 | $36.00 |
| Tier 3Preferred Brand | 22% | 22% | 22% |
| Tier 4Non-Preferred Drug | 32% | 32% | 32% |
| Tier 5Specialty Tier | 25% | Not listed | Not listed |
Long-term care pharmacy costs
| Drug tier | 31 days |
|---|---|
| Tier 1Preferred Generic | $4.00 |
| Tier 2Generic | $12.00 |
| Tier 3Preferred Brand | 22% |
| Tier 4Non-Preferred Drug | 32% |
| Tier 5Specialty Tier | 25% |
Out-of-network pharmacy costs
| Drug tier | 30 days |
|---|---|
| Tier 1Preferred Generic | $4.00 |
| Tier 2Generic | $12.00 |
| Tier 3Preferred Brand | 22% |
| Tier 4Non-Preferred Drug | 32% |
| Tier 5Specialty Tier | 25% |
Drug coverage rules and exceptions
Tier 1: Preferred Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 2: Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 3: Preferred Brand
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 4: Non-Preferred Drug
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- No
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 5: Specialty Tier
- Drugs included in this tier
- Part D Drugs Only
Special cost protections apply to covered insulin and recommended adult vaccines.
Where this plan is offered
CMS lists this plan in 2 states or territories. Availability can vary by county and ZIP code.