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Blue Rx PDP Complete (PDP) - S5593-003-000
$168.20
Monthly Premium
Blue Rx PDP Complete (PDP) is a Medicare Part D Prescription Drug Plan offered by Highmark Health
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$168.20
Monthly Premium
Pennsylvania and West Virginia 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 Pennsylvania and West Virginia Medicare prescription drug plans like the one below and find a plan that offers the benefits you want at an affordable price.
Blue Rx PDP Complete (PDP) - S5593-003-000 Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $168.20 |
| Annual deductible | $0.00 |
| Preferred pharmacies? | Yes |
| Accepts Mail Order? | Yes |
| Star Rating | 3.5 out of 5 stars |
Prescription Drug Costs and Coverage
The Blue Rx PDP Complete (PDP) is a prescription drug plan which offers the following coverage:
Initial Coverage Level
| 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 | $0.00 | $5.00 | 25% | 49% | 33% |
| Standard retail | $4.00 | $10.00 | 25% | 49% | 33% |
| Preferred mail order | N/A | N/A | N/A | N/A | 33% |
| Standard mail order | N/A | N/A | N/A | N/A | 33% |
| 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 | $0.00 | $15.00 | 25% | 49% | N/A |
| Standard retail | $12.00 | $30.00 | 25% | 49% | N/A |
| Preferred mail order | $0.00 | $12.50 | 25% | 49% | N/A |
| Standard mail order | $10.00 | $25.00 | 25% | 49% | N/A |
Plan Documents
| Links to plan documents |
Pennsylvania Counties Served
- Adams
- Allegheny
- Armstrong
- Beaver
- Bedford
- Berks
- Blair
- Bradford
- Bucks
- Butler
- Cambria
- Cameron
- Carbon
- Centre
- Chester
- Clarion
- Clearfield
- Clinton
- Columbia
- Crawford
- Cumberland
- Dauphin
- Delaware
- Elk
- Erie
- Fayette
- Forest
- Franklin
- Fulton
- Greene
- Huntingdon
- Indiana
- Jefferson
- Juniata
- Lackawanna
- Lancaster
- Lawrence
- Lebanon
- Lehigh
- Luzerne
- Lycoming
- Mckean
- Mercer
- Mifflin
- Monroe
- Montgomery
- Montour
- Northampton
- Northumberland
- Perry
- Philadelphia
- Pike
- Potter
- Schuylkill
- Snyder
- Somerset
- Sullivan
- Susquehanna
- Tioga
- Union
- Venango
- Warren
- Washington
- Wayne
- Westmoreland
- Wyoming
- York
West Virginia Counties Served
- Barbour
- Beaver
- Berkeley
- Boone
- Braxton
- Brooke
- Cabell
- Calhoun
- Clay
- Doddridge
- Fayette
- Frederick
- Gilmer
- Grant
- Greenbrier
- Hampshire
- Hancock
- Hardy
- Harrison
- Jackson
- Jefferson
- Kanawha
- Lewis
- Lincoln
- Logan
- Marion
- Marshall
- Mason
- Mcdowell
- Mercer
- Mineral
- Mingo
- Monongalia
- Monroe
- Morgan
- Nicholas
- Ohio
- Pendleton
- Pleasants
- Pocahontas
- Preston
- Putnam
- Raleigh
- Randolph
- Ritchie
- Roane
- Summers
- Taylor
- Tucker
- Tyler
- Upshur
- Wayne
- Webster
- Wetzel
- Wirt
- Wood
- Wyoming