BlueJourney HMO Prescription Drug Benefits

 

BlueJourney Premier HMO

Preferred/Standard

BlueJourney Value HMO

Preferred/Standard

BlueJourney Essential HMO

Preferred/Standard

Deductible

$0

$0

$0

Tier 1 Preferred Generics

$0/$7

$0/$7

$0/$7

Tier 2 Generic Drugs

$0/$8

$5/$15

$5/$15

Tier 3 Preferred Brand

$40/$47

$40/$47

$40/$47

Tier 4 Nonpreferred Drugs

$93/$100

$93/$100

$93/$100

Tier 5 Specialty Drugs

33%

(30 day supply only)

33%

(30 day supply only)

33%

(30 day supply only)

Tier 6 Select Care Drugs

$0/$7

$0/$7

$0/$7

After initial coverage limit reached

Tier 1 generics: 
$0/$7

Tier 2 generics: 
$0/$8

Tier 6 Select Care: 
$0/$7

Brand: 
25% 
30 day supply (31 day LTC)

25% generic

25% brand

30 day supply (31 day LTC)

Part D Excluded Drugs

Not covered

Not covered

Not covered

Part D Senior Saver Model

During the initial and coverage gap stage, your out-of-pocket costs for select insulins will be a $5 copay for 30-day supply of our preferred insulin brands1.


1Select insulin cost-sharing does not apply to members who qualify for low income subsidy.

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Updated October 1, 2020

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