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Medicare HMO Blue ValueRx (HMO)

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Prescription Drug Coverage

Medicare Advantage Pharmacy Network & Formulary

Our Pharmacy and Therapeutics Committee frequently reviews the list of covered medications for safety and effectiveness. To learn more about this process, our formulary, or why changes to the formulary might be made, visit this section.

Prescription Drug Coverage Summary



Annual Deductible Glossary

$0 for Tiers 1 and 2; $310 for Tiers 3, 4 and 5

Initial Coverage Glossary

30-day retail

90-day mail order

Tier 1: Preferred Generic

$4 copay

$4 copay

Tier 2: Non-Preferred Generic

$8 copay

$16 copay

Tier 3: Preferred Brand

$45 copay

$90 copay

Tier 4: Non-Preferred Brand

$95 copay

$190 copay

Tier 5: Specialty Drugs

25% of the cost

25% of the cost

Coverage Gap Glossary

After your total yearly drug costs reach $2,850, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 72% of the plan's costs. For covered brand drugs, you pay no more than 47.5% of the plan's costs (excluding dispensing fees)

Catastrophic Coverage Glossary

After your yearly out-of-pocket drug costs reach $4,550, you pay the greater of:
$2.55 copay for generics or drugs treated like generic drugs $6.35 copay for all other drugs; or 5% of the cost

We may periodically make changes to the formulary (covered drug list). If we remove a medication from the formulary, affected members will be notified in writing before the change is made.

View Medicare Advantage Network & Formulary

Pharmacy Directory

There are over 1,200 pharmacies in our Massachusetts network and over 61,900 pharmacies in our nationwide network. We contract with pharmacies that equal or exceed regulatory requirements for pharmacy access in your area.

(The pharmacies listed in this network may differ from those in the Blue MedicareRxSM (PDP) network. Please call Member Service at 1-800-200-4255 (TTY: 1-800-522-1254), 8:00 a.m. to 8:00 p.m. ET as follows: from October 1 through February 14, seven days a week, and from February 15 through September 30, Monday through Friday, or visit Blue MedicareRx (PDP) for more information.)

*Your monthly premium will be different if you qualify for Extra Help from Medicare.