2023 Blue Rx PDP Plus (PDP) By Highmark Inc.
Blue Rx PDP Plus (PDP) S5593-002 is a Actuarially Equivalent Standard Medicare (Part-D) Prescription Drug Plan by Highmark Inc.. Stand-alone plans offer additional prescription drug coverage only and are an option if you are on Original Medicare insurance or you have a Medicare health plan that does not include Part D coverage. The Blue Rx PDP Plus (PDP) plan has a monthly drug premium of $121.10 and a $505.00 drug deductible.
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S5593-002 Part-D Summary of Benefits
| Plan Name: | Blue Rx PDP Plus (PDP) |
|---|---|
| Provider: | Highmark Inc. |
| Plan ID: | S5593-002 |
| Plan Year: | 2023 |
| State: |
Pennsylvania West Virginia |
| Benefit Type: | Basic |
| Monthly Drug Premium: | $121.10 |
| Drug Deductible: | $505.00 |
| Tiers with No Deductible: | 0 |
| Gap Coverage: | No |
| National Plan: | No |
| Similar Plan: | S5593-003 |
Deductible and Premium for Blue Rx PDP Plus (PDP)
The Blue Rx PDP Plus (PDP) plan has a monthly drug premium of $121.10 and a $505.00 drug deductible. This Highmark Inc. plan offers a $121.10 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $- this Premium covers any enhanced plan benefits offered by Highmark Inc. above and beyond the standard PDP benefits. This can include additional help in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $121.1. The Part D Total Premium is the combined total of the supplemental and basic premiums for some plans this amount can be lower due to negative premiums.
| Part D Basic Premium: | $121.10 |
|---|---|
| Benchmark: | not below the regional benchmark |
| Part D Supplemental Premium | $- |
| Benefit Type: | Actuarially Equivalent Standard |
| Total Part D Premium: | $121.1 |
Highmark Inc. Premium Assistance
The Low Income Subsidy (LIS) helps seniors with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Blue Rx PDP Plus (PDP) medicare insurance plan offers a $80.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $90.30 for 75% low income subsidy $100.6 for 50% and $110.8 for 25%.
| $0 Premium with Full LIS: | No |
|---|---|
| Full LIS Premium: | $80.00 |
| 75% LIS Premium: | $90.30 |
| 50% LIS Premium: | $100.6 |
| 25% LIS Premium: | $110.8 |
S5593-002 Gap Coverage
In 2023 once you and your plan provider have spent $4660 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will still receive a 75% discount on covered brand-name drugs and a discount on generic drugs. Once you reach the coverage gap you will pay 25% of the plans cost for covered brand-name prescription drugs and 25% on generic drugs unless your plan offers additional coverage. This Highmark Inc. plan does not offer additional coverage through the gap.
S5593-002 Formulary or Drug Prices
Blue Rx PDP Plus (PDP) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
| Drug Tier | Copay Preferred Pharmacy |
Copay Nonpreferred Pharmacy |
|---|---|---|
| Tier 1 | $0 | $6 |
| Tier 2 | $7 | $14 |
| Tier 3 | 20% | 25% |
| Tier 4 | 40% | 50% |
| Tier 5 | 25% | 25% |
*Initial Coverage Phase and 30 day supply
Blue Rx PDP Plus (PDP) Plan Reviews
| 2022 Overall Rating | |
|---|---|
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Member Experience with the Drug Plan
| Total Rating | |
|---|---|
| Rating of Drug Plan | |
| Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
| Total Rating | |
|---|---|
| MPF Price Accuracy | |
| Drug Adherence for Diabetes Medications | |
| Drug Adherence for Hypertension (RAS antagonists) | |
| Drug Adherence for Cholesterol (Statins) | |
| MTM Program Completion Rate for CMR |
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating | |
|---|---|
| Complaints about the Drug Plan | |
| Members Choosing to Leave the Plan | |
| Drug Plan Quality Improvement |
Blue Rx PDP Plus (PDP) Drug Plan Customer Service Ratings
| Total Rating | |
|---|---|
| Call Center, TTY, Foreign Language |
Last updated on
Source: CMS.gov
For More Information on Ratings Please See the CMS Tech Notes.
Plans as of October 1, 2022.
Notes: Data are subject to change. All contracts for 2020 have been not finalized. For 2020, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part
Includes 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.
The Humana Prescription Drug Plan (PDP) pharmacy network includes limited lower-cost, preferred pharmacies in urban areas of AR, CT, DE, IA, IN, KY, ME, MI, MN, MO, MS, ND, NY, OH, PR, RI, SD, TN, VT, WI, WV; suburban areas of CT, HI, MA, ME, MI, MT, ND, NJ, NY, OH, PA, PR, RI, WV; and rural areas of IA, MN, MT, ND, NE, SD, VT, WY. There are an extremely limited number of preferred cost share pharmacies in urban areas in the following states: AR, DE, ME, MI, MN, MS, ND, NY, OH, RI, and SD; suburban areas of MT and ND; and rural areas of ND. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call Customer Care at 1-800-281-6918 (TTY: 711) or consult the online pharmacy directory at Humana.com.