Horizon Medicare Blue Rx Saver (PDP)
S5993 - 007 - 0
(4 / 5)
Horizon Medicare Blue Rx Saver (PDP) is a Medicare Part D Prescription Drug Plan by Horizon Blue Cross Blue Shield of New Jersey.
This page features plan details for 2023 Horizon Medicare Blue Rx Saver (PDP) S5993 – 007 – 0.
Locations
Horizon Medicare Blue Rx Saver (PDP) is offered in the following locations.
Plan Overview
Horizon Medicare Blue Rx Saver (PDP) offers the following coverage and cost-sharing.
| Insurer: | Horizon Blue Cross Blue Shield of New Jersey |
| Drugs Covered: | Yes |
Please Note:
- This plan does not charge an annual deductible for all drugs. The $450.00 annual deductible only applies to drugs on certain tiers.
Ready to sign up for Horizon Medicare Blue Rx Saver (PDP) ?
Drug Info
Horizon Medicare Blue Rx Saver (PDP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $450.00 |
| Initial Coverage Limit: | $4,660.00 |
| Catastrophic Coverage Limit: | $7,400.00 |
| Drug Benefit Type: | Enhanced Alternative |
| Gap Coverage: | Yes |
| Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs. The table below shows how the LIS impacts the Part D premium of this plan.| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $59.50 | $50.70 | $42.00 | $33.20 | $24.50 |
Initial Coverage Phase
After you pay your $450.00 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 $4,660.00. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $14.00 copay | $0.00 copay | $0.00 copay |
| 2 (Generic) | $4.00 copay | $20.00 copay | $2.00 copay | $4.00 copay |
| 3 (Preferred Brand) | $35.00 copay | $47.00 copay | $35.00 copay | $35.00 copay |
| 4 (Non-Preferred Drug) | 44% | 46% | 44% | 44% |
| 5 (Specialty Tier) | 25% | 25% |
60 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | ||||
| 2 (Generic) | ||||
| 3 (Preferred Brand) | ||||
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) |
90 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $42.00 copay | $0.00 copay | $0.00 copay |
| 2 (Generic) | $12.00 copay | $60.00 copay | $6.00 copay | $12.00 copay |
| 3 (Preferred Brand) | $105.00 copay | $141.00 copay | $105.00 copay | $105.00 copay |
| 4 (Non-Preferred Drug) | 44% | 46% | 44% | 44% |
| 5 (Specialty Tier) |
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.
30 Day
90 Day
30 Day
90 Day
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, 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 | $4.15 copay or 5% (whichever costs more) |
| Brand-name drugs | $10.35 copay or 5% (whichever costs more) |
Ready to sign up for Horizon Medicare Blue Rx Saver (PDP) ?