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 |
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: 800-859-4880 daily from
8 am to 8 pm.
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 |
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.
EmblemHealth Plan, Inc. is a PPO plan and a standalone PDP with a Medicare contract. Enrollment in EmblemHealth Plan, Inc. depends on contract renewal. EmblemHealth Plan, Inc. are EmblemHealth companies.
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Last Update 10/01/2020
Y0026_ 200570 Accepted 9/29/20