EmblemHealth VIP Rx (PDP)

With EmblemHealth VIP Rx (PDP), you get $2 preferred generic drugs at preferred pharmacies nation-wide. You pay small a premium of $49.30 per month.

 

Your level of Extra Help Premium
0% $49.30
25% $38.70
50% $28.20
75% $17.60
100% $7.00

If you have questions, please call: 800-447-9169 daily from
8 am to 8 pm.

Drug Coverage

Having the medicines you need is an important part of staying healthy, which is why we take our pharmacy offerings very seriously. We strive to help you make sure you can afford the medicines you take. Our formulary gives you access to thousands of them, and our pharmacy network is large enough to provide the choices you need—close to home.

 

    

DEDUCTIBLE

(The amount you pay before your plan starts to pay)

You Pay

INITIAL COVERAGE

$0-$4,130

You Pay

COVERAGE GAP 

Over $4,130

You Pay

CATASTROPHIC 

Over $6,550

You Pay

Tier 1 Preferred Generic Drugs $445 $2 25% of the cost $3.70 or 5% of the cost
Tier 2 Generic Drugs $445 $12 25% of the cost $3.70 or 5% of the cost
Tier 3 Preferred Brand Drugs $445 $40 25% of the cost $9.20 or 5% of the cost 
Tier 4 Non-Preferred Drugs $445 33% of the cost 25% of the cost $3.70, $9.20 or 5% of the cost 

Tier 5 Specialty Drugs

$445 25% of the cost 25% of the cost $3.70, $9.20 or 5% of the cost 

Drug Cost Calculator

Use our Cost Calculator tool to estimate your prescription drug costs. Enter the prescription drugs you take and we'll show you your monthly drug costs.

 

 


Medicare HMO and HMO-POS Provider & HMO Pharmacy Directories

Group Health Incorporated (GHI) is a standalone PDP with a Medicare contract. Enrollment in GHI depends on contract renewal. GHI is an EmblemHealth company.

EmblemHealth Medicare PDP is a PDP plan with a Medicare contract. Enrollment in EmblemHealth Medicare PDP depends on contract renewal.

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Last Update 10/01/2020

Y0026_ 200570  Accepted 9/29/20