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        • Personalized Support for Disease Management
        • Quality Optimizer
        • Additional Programs
      • Mental Health
      • Supporting Caregivers
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2023 Medicare PPO Blue SaverRx

Prescriptions

 

Shop all plans available to you

Part A Eligible:
Coverage Year:
Zip Code:
Change Information

Your Information

What’s Part A?
part-a-date

Understand Plan Features

 Costs & Benefits  Doctors Network  Eligibility  Discount & Programs

Medicare Advantage Pharmacy Network & Formulary

Our Pharmacy and Therapeutics Committee frequently reviews the list of covered medications for safety and effectiveness. To learn more about this process, our formulary, or why changes to the formulary might be made, visit this section.

Important Documents: Prescription Drug Coverage

  • 2023 Medicare PPO Blue SaverRx Formulary (Updated 03/16/2023)
  • Medicare Advantage Appointment of Representative Form
  • Request for Medicare Advantage Prescription Drug Coverage Determination

 - - 

Enroll Online

See all Enrollment Options

We could not find Medicare Advantage Plans available in your area or Please enter a valid zip code.

However, you can choose a Medicare Supplement and Prescription Drug plan.

Prescription Drug Coverage Summary

Prescription Drug Coverage

Cost

Annual Deductible  There is no drug deductible for this plan.

Initial Coverage 

Preferred Cost-Sharing Pharmacies
Amount for 30-day supply

Standard Cost-Sharing Pharmacies
Amount for 30-day supply

CVS Caremark Mail Service
Amount for 90-day supply

Tier 1: Preferred Generic

$0 copay

$10 copay

$0 copay

Tier 2: Generic

$10 copay

$20 copay

$20 copay

Tier 3: Preferred Brand

$42 copay

$47 copay

$84 copay

Tier 4: Non-Preferred Drug

$95 copay

$100 copay

$190 copay

Tier 5: Specialty Drugs

30% of the cost

30% of the cost

Not available at 90-day supply

Coverage Gap 

After your total yearly drug costs reach $4,660, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 25% of the plan's costs. For covered brand drugs, you pay no more than 25% of the plan's costs (excluding dispensing fees).

Catastrophic Coverage 

After your yearly out-of-pocket drug costs reach $7,400 you pay the greater of:

  • $4.15 copay for generics or drugs treated like generic drugs and a $10.35 copay for all other drugs; or
  • 5% of the cost

CVS Caremark, an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts.

Pharmacy Directory

There are over 1,000 pharmacies in our Massachusetts network and over 60,000 pharmacies in our nationwide network. We contract with pharmacies that equal or exceed regulatory requirements for pharmacy access in your area.

Find a Pharmacy Near You

  • Use our online pharmacy search tool 
  • Download the pharmacy directory: 2023 Medicare Advantage Pharmacy Directory

We may periodically make changes to the comprehensive formulary (covered drug list). If we remove a medication from the formulary, affected members will be notified in writing before the change is made.

Learn More

View Medicare Advantage Network and Formulary

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  • Your monthly premium will be different if you qualify for Extra Help from Medicare.
  • This information is not a complete description of benefits. Call 1-800-200-4255 (TTY: 711) for more information.
  • Every year, Medicare evaluates plans based on a 5-star rating system.

Blue Cross Blue Shield of Massachusetts is an HMO and PPO Plan with a Medicare contract. Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities that have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal.

You can file a complaint if you feel that you received inaccurate, misleading or inappropriate information. Please call Member Service at 1-800-200-4255 (TTY users call: 711). If your complaint involves a broker or agent, be sure to include the name of the broker/agent when filing your complaint.

Y0014_22146
S2893_2244
Last Updated: 03/16/2023

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