How to determine your drug cost
It can be a challenge to estimate your prescription drug cost. MedicareBlue Rx has provided instructions to help you determine your drug cost.
How to Determine Your Drug Cost
Medicare Part D, also called the Medicare prescription drug benefit, is an optional benefit to help Medicare beneficiaries pay for prescription drugs. The State has a Medicare Part D plan, Iowa Group MedicareBlue Rx ($5/$10/20%/45%/33%) available to Medicare-eligible State retirees. Iowa Group MedicareBlue Rx ($5/$10/20%/45%/33%) is available with:
- Iowa Choice
- National Choice
- Group Program F
- Group Program N
Group MedicareBlue Rx Resources
- Overview Group MedicareBlue Rx (PDP) $5/$10/20%/45%/33%
- MedicareBlue RX Summary of Benefits (PDP)
- 2024 Medicare Star Rating
Group MedicareBlue Rx ($5/$10/20%/45%/33%) Summary
- The plan does not have a deductible. You have first dollar coverage.
- The plan has five formulary tiers.
- Your cost for prescriptions on Tier 1: Preferred Generic and Tier 2: Non-Preferred Generic are a copay. $5 copay for Tier 1 and $10 copay for Tier 2.
- Tiers 3 and 4 are brand name drugs. Your cost for prescriptions on Tiers 3 β 5 is coinsurance.
- Tier 5 are specialty drugs. Specialty drugs are high-cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis, and multiple sclerosis. Specialty drugs sometimes require special handling and administration (typically injection or infusion), and patients using a specialty drug may need careful oversight from a health care provider who can watch for side effects and ensure that the medication is working as intended. Your cost for specialty drugs is a coinsurance of 33 percent.
Premium
The 2024 premium is $105.50 per month*.
*Since January 1, 2011, higher-income beneficiaries will pay an additional amount to Social Security/Medicare for Medicare Part D coverage.
Group MedicareBlue Rx ($5/$10/20%/45%/33%) with Iowa Choice or National Choice
If you are eligible for Medicare and choose Iowa Choice or National Choice, you can significantly reduce your Wellmark premium for either option by enrolling in Group MedicareBlue Rx ($5/$10/20%/45%/33%).
Group MedicareBlue Rx and Wellmark will work together for your prescription needs. Enrollment in the Group MedicareBlue Rx plan significantly reduces the amount Wellmark pays for prescription drug coverage. These savings are passed along to you in the form of lower premiums for your Iowa Choice or National Choice health coverage.
You will have two ID cards - Group MedicareBlue Rx and Wellmark. You will use the Group MedicareBlue Rx ID card in addition to your Wellmark ID card at the pharmacy. You must show both of these identification cards at the pharmacy for claims to be filed correctly. Tell your pharmacist to file your claim under the Group MedicareBlue Rx card first, and then under your State of Iowa Wellmark plan card. Under the coordinated pharmacy benefits, Group MedicareBlue Rx will pay your claims as primary and the State of Iowa's Wellmark plan will pay as secondary. You need to make sure your pharmacy files your claims this way in order to receive the correct State of Iowa plan copayments.
Important information regarding Group MedicareBlue Rx:
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The Group MedicareBlue Rx plan was created specifically for State of Iowa retirees. It is the only Medicare Part D plan which will lower your health insurance premiums.
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If you drop Group MedicareBlue Rx and purchase another Medicare Part D plan (including a different MedicareBlue Rx plan), you will pay the higher Wellmark premium.
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You must complete and submit your Group MedicareBlue Rx application prior to the month coverage begins.
Pharmacy Coverage with Group Program F or Group Program N
If you are enrolled in Group Program F or Group Program N, you may:
- Maintain coverage with the Group MedicareBlue Rx, OR
- Elect an individual Medicare Prescription Drug Program from an insurance company offering a Medicare Part D program in your state.
If you elect an Individual Medicare Part D plan, you can return to Group MedicareBlue Rx during the next Enrollment and Change period.
Group MedicareBlue Rx Iowa Customer Service
Once you are enrolled in Group MedicareBlue Rx, you can can contact their customer service area at 877.838.3827 (toll-free) with any questions you may have.
Extra Help
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:
Medicare
1-800-MEDICARE (1-800-633-4227)
1-877-486-2048 (TTY/TTD)
24 hours a day, 7 days a week
Social Security Administration
1-800-772-1213
1-800-325-0778 (TTY/TDD)
Between 7:00 am and 8:00 pm, Monday through Friday
Your State Medicaid Office
For More Information
Contact the Department of Administrative Services, Human Resources Enterprise at 866.895.2464 or email stateretirees@iowa.gov if you have any questions or need additional information.
The Department of Administrative Services β Human Resources Enterprise is providing this information about the State of Iowaβs benefits. The information on this web page is subject to change. Nothing herein shall be construed as a guarantee of benefits. This webpage is not a complete description of the State of Iowaβs benefit plans. Nothing on this web page supersedes or changes any of the terms and conditions of any plan documents, insurance policies, or other legal agreements. If the wording in this web page contradicts any plan documents, laws, regulations, administrative rules, insurance policies, or other legal agreements, the wording in the official documents and agreements will govern.