EmblemHealth VIP Rx Plus (PDP)

With VIP Rx Plus, you get $0 preferred generic and generic drugs at preferred pharmacies nation-wide and when you use our mail order pharmacy. The deductible does not apply to drugs on Tiers 1, 2 and 3, so you save on the medicines you need.

 

Your level of Extra Help Premium
0% $72.50
25% $61.90
50% $51.40
75% $40.80
100% $30.20

If you have any 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-$3,970

You Pay
Coverage Gap Over $3,970

You Pay
Catastrophic Over $6,550

You Pay
Tier 1 Preferred Generic Drugs No Deductible $0 25% of the cost $3.70 or 5% of the cost
Tier 2 Generic Drugs No Deductible $0 25% of the cost
$3.70 or 5% of the cost
Tier 3 Preferred Brand Drugs No Deductible $35 25% of the cost
$9.20 or 5% of the cost
Tier 4 Non-Preferred Drugs $285 $95 25% of the cost
$3.70, $9.20 or 5% of the cost
Tier 5 Specialty Drugs $285 28% 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 PDP Pharmacy Directory

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

 

You will need the Adobe® Acrobat Reader software to view files in the Portable Document Format (PDF). If you don’t already have it, you can download a copy from Adobe® here.

Last Update 10/01/2020

Y0026_ 200570  Accepted 9/29/20