Breadcrumb

Medicare Banner

Plan Details

Horizon Medicare Blue Rx Saver (PDP)

< Back to Plan Pricing

MONTHLY PREMIUM

$23.50

ENROLL
BENEFIT TYPE IN NETWORK BENEFIT
Annual Deductible
Annual Deductible $150 per year for Tiers 3, 4 and 5 for Part D prescription drugs.
Initial Coverage
Initial Coverage

Standard Pharmacy One-month supply:

  • Tier 1 (Preferred Generic): $0 Copay
  • Tier 2 (Generic): $10 Copay
  • Tier 3 (Preferred Brand): $45 Copay
  • Tier 4 (Non-Preferred Drug): 45% Copay
  • Tier 5 (Specialty Tier): 30% of the cost

Standard Mail Order Three-month supply:

  • Tier 1 (Preferred Generic): $0 Copay
  • Tier 2 (Generic): $15 Copay
  • Tier 3 (Preferred Brand): $135 Copay
  • Tier 4 (Non-Preferred Drug): 45% of the cost
  • Tier 5 (Specialty Tier): Not offered

If you reside in a long-term facility, you pay the same as at a retail pharmacy. You may get drugs from an out-of-network pharmacy, but may pay more than you pay at an in-network pharmacy.

Coverage Gap
Coverage Gap

The Coverage Gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $4,130. After you enter the Coverage Gap , you pay 25% of the plan’s cost for covered brand name drugs and 25% of the plan’s cost for covered generic drugs until your costs total $6,550.

Catastrophic Coverage
Catastrophic Coverage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reaches $6,550, you pay the greater of:

  • 5% of the cost, or
  • $3.70 Copay for generic (including brand drugs treated as generic) and an $9.20 Copay for all other drugs.

Find In-Network Doctors

If you need to find a new doctor who participates in one of our networks, our Doctor & Hospital finder makes it easy to find a health care professional who matches your needs.

Find In-Network Pharmacies

Search from more than 66,000 in-network pharmacies at Prime Therapeutics.

Find Covered Prescription Drugs

Find formulary drugs, prior authorization, and step therapy at Prime Therapeutics.