Horizon Medicare Blue Rx Standard (PDP)
S5993 - 001 - 0
(2.5 / 5)
Horizon Medicare Blue Rx Standard (PDP) is a Medicare Part D Prescription Drug Plan by Horizon Blue Cross Blue Shield of New Jersey.
This page features plan details for 2024 Horizon Medicare Blue Rx Standard (PDP) S5993 – 001 – 0.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Horizon Medicare Blue Rx Standard (PDP) is offered in the following locations.
Plan Overview
Horizon Medicare Blue Rx Standard (PDP) offers the following coverage and cost-sharing.
| Insurer: | Horizon Blue Cross Blue Shield of New Jersey |
| Drugs Covered: | Yes |
Ready to sign up for Horizon Medicare Blue Rx Standard (PDP) ?
Drug Info
Horizon Medicare Blue Rx Standard (PDP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $545.00 |
| Initial Coverage Limit: | $5,030.00 |
| Catastrophic Coverage Limit: | $8,000.00 |
| Drug Benefit Type: | Basic |
| Additional Gap Coverage: | No |
| 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 Full |
|---|---|
| $64.80 | $19.30 |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
Initial Coverage Phase
After you pay your $545.00 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 $5,030.00. 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) | $10.00 copay | $5.00 copay | $10.00 copay | |
| 2 (Generic) | $20.00 copay | $10.00 copay | $20.00 copay | |
| 3 (Preferred Brand) | $40.00 copay | $40.00 copay | $40.00 copay | |
| 4 (Non-Preferred Drug) | 45% | 45% | 45% | |
| 5 (Specialty Tier) | 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) | $30.00 copay | $15.00 copay | $30.00 copay | |
| 2 (Generic) | $60.00 copay | $30.00 copay | $60.00 copay | |
| 3 (Preferred Brand) | $120.00 copay | $120.00 copay | $120.00 copay | |
| 4 (Non-Preferred Drug) | 45% | 45% | 45% | |
| 5 (Specialty Tier) |
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
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 $8,000.00, you pay nothing for Medicare Part D covered drugs.
Ready to sign up for Horizon Medicare Blue Rx Standard (PDP) ?