Blue MedicareRx Plan Important Terms

Brand-name Drugs: Prescription drugs that are protected by patent and typically produced and sold by one manufacturer.

Coinsurance: The share of expenses (a percentage of the cost of the drug) that a member pays for certain covered drugs.

Copayment: Usually a set, flat-dollar amount that a member pays for certain covered drugs.

Cost Sharing: When the member pays a portion of the cost of the drug with the Prescription Drug Plan. Examples of cost sharing are coinsurance, copayments, and deductibles.

Coverage Gap: Once you and Blue MedicareRx have paid $2400 in annual covered prescription drug expenses, you will be responsible for paying more or all of the cost for your medications, depending on the plan you choose, until your total out-of-pocket expenses reach $ 3850.

With Blue MedicareRx Value and Plus plans, you are responsible for 100% of drug costs in the coverage gap. With Blue MedicareRx Premier plan, you will have benefits for covered generic drugs in the coverage gap.

After the coverage gap ends, (after you have paid $3850 in annual out-of-pocket costs), your share of the cost for covered prescription drugs is minimal.

Deductible: A dollar amount a health care plan memeber must pay for covered services each calendar year before the health care plan begins paying for covered services.

Formulary: Also known as a drug list. A list of the prescription drugs that are covered by a health care plan.

Generic Drugs: Prescription drugs that have the same active ingredient as equivalent brand-name drugs. Generic prescription drugs usually cost less than brand-name drugs and are required by the Food and Drug Administration (FDA) to be as safe and effective as the brand-name drug.

Injectable Drugs: These medications are frequently given by injection or infusion and often require special packaging, mailing, and storage. In some materials, you will find injectable drugs referred to as specialty and non-specialty.

Specialty injectable drugs are usually high-cost, unique drugs used to treat conditions such as multiple sclerosis, hepaititis C, rheumatoid arthritis, or cancer.

Non-specialty injectable drugs are used to treat less costly chronic conditions, as compared to specialty agents. One example is injectable antibiotics.

Network Pharmacies: Pharmacies that have agreed to fill prescriptions for our members. You will get the most from your prescription drug benefits when you visit a network pharmacy.

Non-network Pharmacies: At non-network pharmacies, you will be responsible for the difference between the network and non-network pharmacy costs, in additon to your copayment. This does not apply in emergency situations, or when you do not have adequate access to a network retail pharmacy.

Non-preferred Brand Drugs: Certain brand-name prescription drugs that are covered in order to offer a larger choice of medications. Your share of the cost is higher for non-preferred brand drugs compared to preferred brands.

PDP: Prescription Drug Plan, a company approved by Medicare that has a contract with the government to provide prescription drug coverage to people on Medicare.

Preferred Brand Drugs: A brand-name prescription drug that will cost you less than drugs that are considered non-preffered brand drugs. Preferred Multi-source Brand drugs are brand drugs that are available through multiple manufacturers and that have a generic option.

Preferred Pharmacies: Available only for mail service and specialty medications, where members are expected to receive the largest savings through their prescription benefit.

Retail 90-Day Pharmacies: Pharmacies within our network that have agreed to fill 90-day supllies of prescription medications, helping to eliminate multiple trips to the pharmacy.

Enjoy the Convenience of Extened Supplies: Many prescription drugs are available in 90-day extended supplies, when appropriate. We offer extended supplies through Preferred Mail Order Pharmacies. Or, avoid multiple trips to the pharmacy with Retail 90-day Pharmacies.

Blue MedicareRx Plan Important Terms Brand-name Drugs: Prescription drugs that are protected by patent and typically produced and sold by one manufacturer. Coinsurance: The share of expenses (a percentage of the cost of the drug) that a member pays for certain covered drugs. Copayment: Usually a set, flat-dollar amount that a member pays for certain covered drugs. Cost Sharing: When the member pays a portion of the cost of the drug with the Prescription Drug Plan. Examples of cost sharing are coinsurance, copayments, and deductibles. Coverage Gap: Once you and Blue MedicareRx have paid $2400 in annual covered prescription drug expenses, you will be responsible for paying more or all of the cost for your medications, depending on the plan you choose, until your total out-of-pocket expenses reach $ 3850. With Blue MedicareRx Value and Plus plans, you are responsible for 100% of drug costs in the coverage gap. With Blue MedicareRx Premier plan, you will have benefits for covered generic drugs in the coverage gap. After the coverage gap ends, (after you have paid $3850 in annual out-of-pocket costs), your share of the cost for covered prescription drugs is minimal. Deductible: A dollar amount a health care plan memeber must pay for covered services each calendar year before the health care plan begins paying for covered services. Formulary: Also known as a drug list. A list of the prescription drugs that are covered by a health care plan. Generic Drugs: Prescription drugs that have the same active ingredient as equivalent brand-name drugs. Generic prescription drugs usually cost less than brand-name drugs and are required by the Food and Drug Administration (FDA) to be as safe and effective as the brand-name drug. Injectable Drugs: These medications are frequently given by injection or infusion and often require special packaging, mailing, and storage. In some materials, you will find injectable drugs referred to as specialty and non-specialty. Specialty injectable drugs are usually high-cost, unique drugs used to treat conditions such as multiple sclerosis, hepaititis C, rheumatoid arthritis, or cancer. Non-specialty injectable drugs are used to treat less costly chronic conditions, as compared to specialty agents. One example is injectable antibiotics. Network Pharmacies: Pharmacies that have agreed to fill prescriptions for our members. You will get the most from your prescription drug benefits when you visit a network pharmacy. Non-network Pharmacies: At non-network pharmacies, you will be responsible for the difference between the network and non-network pharmacy costs, in additon to your copayment. This does not apply in emergency situations, or when you do not have adequate access to a network retail pharmacy. Non-preferred Brand Drugs: Certain brand-name prescription drugs that are covered in order to offer a larger choice of medications. Your share of the cost is higher for non-preferred brand drugs compared to preferred brands. PDP: Prescription Drug Plan, a company approved by Medicare that has a contract with the government to provide prescription drug coverage to people on Medicare. Preferred Brand Drugs: A brand-name prescription drug that will cost you less than drugs that are considered non-preffered brand drugs. Preferred Multi-source Brand drugs are brand drugs that are available through multiple manufacturers and that have a generic option. Preferred Pharmacies: Available only for mail service and specialty medications, where members are expected to receive the largest savings through their prescription benefit. Retail 90-Day Pharmacies: Pharmacies within our network that have agreed to fill 90-day supllies of prescription medications, helping to eliminate multiple trips to the pharmacy. Enjoy the Convenience of Extened Supplies: Many prescription drugs are available in 90-day extended supplies, when appropriate. We offer extended supplies through Preferred Mail Order Pharmacies. Or, avoid multiple trips to the pharmacy with Retail 90-day Pharmacies.