Member: I’ve heard the term “drug stages” in reference to my prescription drug coverage. What are these stages and how do they affect my coverage? —Samantha, Eden Prairie
Anita: Thank you for the question, Samantha. You aren’t the first person to have questions about prescription drug stages. Generally, the stages affect how much you pay for your prescription medications throughout the calendar year. We usually talk about four stages of coverage, but for your health plan, there are only two stages you need to be aware of.
The first is the Initial Coverage stage. You begin this stage when you fill your first prescription of the year. While in the Initial Coverage stage, the plan pays its share of the cost of your drugs and you, or others on your behalf, pay your share of the cost.
You will usually stay in this stage until the amount of your out-of-pocket costs reaches $7,050. Then you move into the Catastrophic Coverage stage.
In the Catastrophic Coverage stage, the plan will pay for all of your covered drugs. You do not have to pay anything for your prescriptions. Once you enter the Catastrophic Coverage stage, you stay in it for the rest of the calendar year.
Regardless of what stage you are in, it’s important to be mindful of the medications you are taking. Talk to your doctor about whether generic drugs might be a good substitute for more expensive brand-name drugs. You can also arrange a Comprehensive Medication Review with your pharmacist, or a Blue Cross pharmacist, to get a better handle on all your medications. Call 1-866-873-5941, Monday through Friday, 9 a.m. to 5 p.m. You can also email BCBSMN.Medicare.CMR@bluecrossmn.com to learn more.
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