If you live in New York and need help paying for medications, Empire has options for you. We have Medicare Advantage Plans that include prescription drug benefits and more. If you're looking for standalone Part D plans without medical coverage, Empire offers drug plans with Blue Rx. Blue Rx plans offer broad coverage, and low monthly premiums.
Explore the benefits you could have with a Blue Rx Part D plan in New York.
Use our prescription search tool to check if we cover your medications.
The cost of your Medicare Prescription Drug Coverage can depend on the plan you pick and how much money you make. People with higher incomes pay premiums that are a little higher. So depending on your plan, you may have some of the following costs:
The bill that you pay every month for your plan. This bill comes from us, but you can usually arrange to have it taken straight out of Social Security.
An annual amount of money you need to spend before your plan kicks in to pay for you or help you pay.
The percentage or fixed amount that you pay when you get prescriptions filled at the pharmacy.
A limit to how much plans can cover in a calendar year. If you reach that limit, you may have to pay for your full medication costs until the end of the year. (Check out exceptions to this limit below.)
You might qualify for more help. A federal program called Extra Help gives you coverage for the premiums, deductibles, copays, and coinsurance expenses of Medicare Part D (drug plan coverage). To qualify, you must be receiving Original Medicare, living in the United States, and your combined income and assets can’t be worth more than a certain amount ($13,640 as an individual or $27,150 when living with your spouse.) If you qualify for Extra Help, you can enroll in Medicare Part D Drug Plans anytime without having to pay any late enrollment fees.
Here are some terms you might run into with Medicare Prescription Drug Coverage.
All the drugs Anthem covers are divided up into pricing tiers. Basically, generic drugs are the lowest tier and are the most affordable, while brand name medications and specialty drugs are in higher tiers that cost more.
In order to cover certain prescription drugs, your plan may require your doctor to clear it with us before writing the prescription and let us know that it’s medically necessary for you.
For some conditions, there are drugs that do the same thing at different prices. With Step Therapy, you and your doctor can agree to try a less expensive drug first, then “step up” to more expensive drugs if that one isn’t working, or if it becomes medically necessary to do so.
For safety reasons, your Prescription Drug Plan may limit the amount of a specific drug you can get. If you refill a prescription too soon, or if you’re prescribed an amount above safety standards, your doctor may need to call us before refilling your prescription in order to keep you covered.
You and your doctor have the right to ask for exceptions to the limits of your drug plan. You can also apply for an exception from step therapy and quantity limits, or for a lower copayment for a specific drug. Talk to your doctor about getting exceptions when you need them.
The Medication Therapy Management (MTM) Program is a service for members with multiple health conditions to help you understand your medications and use them safely. The program is designed to help you and your doctor make sure that your medicines are working to improve your health. If you qualify, you’ll be auto-enrolled in the program. To qualify for the MTM program, you must be managing 3 or more chronic health problems, take 8 or more daily medicines and spend a cost amount indicated by Centers for Medicare & Medicaid Services each year on Part D covered medications. If you qualify, you’ll get a comprehensive medication review and can talk to a pharmacist directly. A summary of that review along with an action plan and personal medication list will be sent to you. You can use these to keep track of your medications and to have available when visiting your doctors. At least once every 3 months, you’ll get a review of your medications with your doctors involved if needed. MTM services are provided at no additional cost to you and while you may choose not to participate in the program, we recommended that you make use of this free service.
If your state isn't listed, check out bcbs.com to find coverage in your area.
Y0114_20_125719_U_M CMS Accepted 10/1/2020
Blue Rx is a PDP plan with a Medicare contract. Enrollment in Blue Rx depends on contract renewal. Empire HealthChoice is the legal entity who has contracted with the Centers for Medicare & Medicaid Services (CMS) to offer the Part D plan(s) noted. Administered by Empire BlueCross BlueShield and Empire BlueCross in cooperation with Excellus BlueCross BlueShield, BlueCross BlueShield of Western New York, and Blue Shield of Northeastern New York. Independent licensees of Blue Cross Blue Shield Association..
This information is not a complete description of benefits. Call Customer Service, (TTY:711) for more information.
Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Call our Customer Service number, (TTY: 711). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a nuestro número de Servicio de Atención al Cliente (TTY: 711). 注意：如果您使用非英語的其他語言，您可以免費獲得語言援助服務。請致電聯絡客戶服務部（聽語障用戶請致電：711）。
