Anthem MediBlue Rx Standard (PDP) - S5596-017-000

3.5 out of 5 stars* for plan year 2025

$89.70

Monthly Premium

Anthem MediBlue Rx Standard (PDP) is a Medicare Part D Prescription Drug Plan offered by Anthem Inc.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$89.70

Monthly Premium

Kentucky and Indiana Medicare beneficiaries may want to consider reviewing their Medicare prescription drug coverage options, such as a standalone Part D prescription drug plan (PDP) or a Medicare Advantage (Medicare Part C) plan that includes drug coverage.

A Part D plan can be used alongside your Original Medicare (Part A and Part B) coverage. A Medicare Advantage plan that includes drug coverage combines your Part A, Part B and Part D benefits into a single plan

Learn more about Kentucky and Indiana Medicare prescription drug plans like the one below and find a plan that offers the benefits you want at an affordable price.

Anthem MediBlue Rx Standard (PDP) - S5596-017-000 Basic Costs and Coverage

Coverage	Details
Monthly plan premium	$89.70
Annual deductible	$590.00
Preferred pharmacies?	Yes
Accepts Mail Order?	Yes
Star Rating	3.5 out of 5 stars

Prescription Drug Costs and Coverage

The Anthem MediBlue Rx Standard (PDP) is a prescription drug plan which offers the following coverage:

Initial Coverage Level

30 day supply
60 day supply
90 day supply

Tiers	Tier 1 Preferred Generic Drug	Tier 2 Generic Drug	Tier 3 Preferred Brand Drug	Tier 4 Non-Preferred Drug	Tier 5 Specialty Tier Drug
Preferred retail	$1.00	$4.00	17%	44%	25%
Standard retail	$4.00	$7.00	17%	44%	25%
Standard mail order	$1.00	$4.00	17%	44%	25%

Tiers	Tier 1 Preferred Generic Drug	Tier 2 Generic Drug	Tier 3 Preferred Brand Drug	Tier 4 Non-Preferred Drug	Tier 5 Specialty Tier Drug
Preferred retail	$2.00	$8.00	17%	44%	N/A
Standard retail	$8.00	$14.00	17%	44%	N/A
Standard mail order	$2.00	$8.00	17%	44%	N/A

Tiers	Tier 1 Preferred Generic Drug	Tier 2 Generic Drug	Tier 3 Preferred Brand Drug	Tier 4 Non-Preferred Drug	Tier 5 Specialty Tier Drug
Preferred retail	$3.00	$12.00	17%	44%	N/A
Standard retail	$12.00	$21.00	17%	44%	N/A
Standard mail order	$3.00	$12.00	17%	44%	N/A

Eligibility & Enrollment

Costs & Coverage

News & Resources

Anthem MediBlue Rx Standard (PDP) - S5596-017-000

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Anthem MediBlue Rx Standard (PDP) - S5596-017-000 Basic Costs and Coverage

Prescription Drug Costs and Coverage

Plan Documents

Kentucky Counties Served

Indiana Counties Served