BlueCross Rx Value (PDP) is a Medicare Prescription Drug Plan by Blue Cross Blue Shield of South Carolina.
This page features plan details for 2022 BlueCross Rx Value (PDP) S5953 – 001.
BlueCross Rx Value (PDP) is offered in the following locations.
BlueCross Rx Value (PDP) offers the following coverage and cost-sharing.
| Insurer: | Blue Cross Blue Shield of South Carolina |
| Drugs Covered: | Yes |
Ready to sign up for BlueCross Rx Value (PDP) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $0.00 | $ | $115.90 | $0.00 | $ |
BlueCross Rx Value (PDP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $400.00 |
| Initial Coverage Limit: | $4,430.00 |
| Catastrophic Coverage Limit: | $7,050.00 |
| Drug Benefit Type: | Basic |
| Gap Coverage: | No |
| Formulary Link: | Formulary Link |
| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $115.90 | $108.1 | $100.3 | $92.6 | $84.80 |
After you pay your $400.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00. Once you reach that amount, you will enter the next coverage phase.
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $5.00 copay | $10.00 copay | $5.00 copay | $10.00 copay |
| 2 (Generic) | $15.00 copay | $20.00 copay | $15.00 copay | $20.00 copay |
| 3 (Preferred Brand) | $40.00 copay | $47.00 copay | $40.00 copay | $47.00 copay |
| 4 (Non-Preferred Drug) | 45% | 50% | 45% | 50% |
| 5 (Specialty Tier) | 26% | 26% | 26% | 26% |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | ||||
| 2 (Generic) | ||||
| 3 (Preferred Brand) | ||||
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $15.00 copay | $30.00 copay | $12.50 copay | $25.00 copay |
| 2 (Generic) | $45.00 copay | $60.00 copay | $37.50 copay | $50.00 copay |
| 3 (Preferred Brand) | $120.00 copay | $141.00 copay | $100.00 copay | $117.50 copay |
| 4 (Non-Preferred Drug) | 45% | 50% | 45% | 50% |
| 5 (Specialty Tier) | 26% | 26% | 26% | 26% |
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | $3.95 copay or 5% (whichever costs more) |
| Brand-name drugs | $9.85 copay or 5% (whichever costs more) |
Ready to sign up for BlueCross Rx Value (PDP) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Need more information on BlueCross Rx Value (PDP)? See 2025 BlueCross Rx Value (PDP) at MedicareAdvantageRX.com.
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint
SMID: MULTIPLAN_HCIHNDOGMED01PY25_M
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