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State of Iowa retiree group MedicareBlue Rx℠ (PDP) enrollment materials

The State offers two group MedicareBlue Rx options to coordinate with Program N and Program F — Basic and Plus. If you choose the Program N or F health plan, you must choose either the Basic or Plus Group MedicareBlue Rx drug plan.

Group MedicareBlue Rx benefits are provided through a four-tier program. The amount of your copayment is determined by the tier on which the drug resides. You pay a copayment at the time you receive your prescription. Have questions? Review the FAQ PDF File.

Basic drug plan - $90.20 monthly premium

Drug Level 30-Day Supply
(retail)		 90-Day Supply
(retail2)		 90-Day Supply
(mail order and preferred pharmacy2)
Tier 1: Generic Drugs $10 copay $30 copay $20 copay
Tier 2: Preferred Brand Drugs $30 copay $90 copay $60 copay
Tier 3: Non-Preferred Brand Drugs $50 copay $150 copay $100 copay
Tier 4: Specialty Drugs $50 copay $150 copay $100 copay
Supplemental Drugs1 25% coinsurance 25% coinsurance 25% coinsurance
Coverage Gap $10 copay for Tier 1
Generic Drug 		$30 copay for Tier 1
Generic Drug 		$20 copay for Tier 1
Generic Drug

Plus drug plan - $139.90 monthly premium

Drug Level 30-Day Supply
(retail)		 90-Day Supply
(retail2)		 90-Day Supply
(mail order and preferred pharmacy2)
Tier 1: Generic Drugs $10 copay $30 copay $20 copay
Tier 2: Preferred Brand Drugs $25 copay $75 copay $50 copay
Tier 3: Non-Preferred Brand Drugs $40 copay $120 copay $80 copay
Tier 4: Specialty Drugs 25% coinsurance 25% coinsurance 25% coinsurance
Supplemental Drugs1 25% coinsurance 25% coinsurance 25% coinsurance
Coverage Gap

Pay the same copays as in the initial coverage period (no change)
for all drug tiers

Interested in enrolling in a group MedicareBlue Rx plan?

Here's how the Group MedicareBlue Rx plans work, including the coverage gap. 

Your drug costs are tracked for you

Your drug costs are tracked by the plan to determine when you move from one stage of coverage to the next. "Total yearly drug costs" determine when you enter the coverage gap stage. They are the amounts you and the plan have paid for covered drugs in a calendar year. This does not include any premiums.

The costs used to determine when you enter the catastrophic coverage stage are slightly different. "True out-of-pocket drug costs" refers to the amounts you have paid for covered drugs in a calendar year. This does not include the amount the plan has paid or any premiums.

Network of pharmacies

Group MedicareBlue Rx members must use network pharmacies to access their prescription drug benefits, except under emergency or nonroutine circumstances when they cannot reasonably use network pharmacies. The Group MedicareBlue Rx Pharmacy Network includes more than 67,000 participating pharmacies nationwide. You can find a network pharmacy at www.YourMedicareSolutions.comExternal Site .

Specialty drug coverage

Medicare classifies certain unique and high-cost medications as specialty drugs. These include injectable antibiotics, transplant drugs, certain chemotherapy drugs and other self-injectable or administered drugs. The specialty drug coverage included with Group MedicareBlue Rx gives you access to these medications and reduces the cost you pay for them.

A list of specialty drugs is available in the enrollment materials section below.

1Supplemental drug coverage

Group MedicareBlue Rx coverage includes some drugs Medicare does not cover and are not on the formulary. You can purchase these select drugs at a 25 percent coinsurance. Money spent on supplemental drugs does not count toward your out-of-pocket maximum for catastrophic coverage.

A list of supplemental drugs is available in the enrollment materials section below.

If you need additional information about Group MedicareBlue Rx, contact Group MedicareBlue Rx at:

Enrollment Customer Service

1-866-434-2037
1-866-456-1550 (TTY)
8 a.m. to 8 p.m. daily, Central Time

290-Day supply

If you choose a 90-day supply at select retail pharmacies, you will pay the equivalent of three copays.

If you choose a 90-day supply by mail order or from a Preferred Extended Supply pharmacy, you will pay the equivalent of two copays. A list of Preferred Extended Supply pharmacies is available at the Group MedicareBlue Rx pharmacy directory at www.YourMedicareSolutions.comExternal Site or call Group MedicareBlue Rx enrollment customer service at:

1-866-434-2037
1-866-456-1550 (TTY)
8 a.m. to 8 p.m. daily, Central Time

You can email MedicareBlue Solutions customer service at www.YourMedicareSolutions.comExternal Site .

Enrollment in group MedicareBlue Rx

The materials needed to enroll in the State of Iowa Retiree Group MedicareBlue Rx prescription drug plan are included on this page. Please review all materials and complete the application.

Group MedicareBlue Rx Summary of Benefits

These documents contain full plan details for the Basic and Plus drug plans.

Group MedicareBlue Rx Formulary

This formulary lists all of the prescription drugs covered by Group MedicareBlue Rx.

Group MedicareBlue Rx Enrollment Form

This is the Group MedicareBlue Rx enrollment form or application. Please complete the form, filling in all sections. After you download and complete the form, please print a copy, sign the form and return it to the State of Iowa retiree services.

Group MedicareBlue Rx Electronic Funds Transfer(EFT) Form

Complete this form to establish an automatic electronic funds transfer (EFT) to pay your monthly Group MedicareBlue Rx premium.

Enrollment in Group Program N and Program F

The materials needed to enroll in the State of Iowa Retiree Group Program N and Program F are included on this page. Please review all materials and complete the application.

Remember: You must submit a Group Program N or F enrollment form in addition to the Group MedicareBlue Rx application for new enrollments. If you already have Group Program N and Group MedicareBlue Rx, but want to switch between Basic and Plus, you only have to fill out a Group MedicareBlue Rx enrollment form. 

Group Program N and F Enrollment Form

This is the Group Program N and F enrollment form or application. Please complete the form, filling in all sections. After you download and complete the form, please print a copy, sign the form and return it to the State of Iowa Retiree Services.

Complete and mail applications to:

Department of Administrative Services
Human Resources Enterprise
ATTN: Kendra McCanley
Hoover Building, Level A
1305 E. Walnut Street
Des Moines, IA 50319-0150

Questions? 

Medicare
1-800-MEDICARE (1-800-633-4227) 
1-877-486-2048 (TTY)
24 hours a day, 7 days a week

Social Security Administration
1-800-772-1213
Users should call 1-800-325-0778 (TTY) between 7 a.m. and 8 p.m., Monday through Friday

Your State Medicaid Office

Group MedicareBlue Rx is a Medicare approved Part D sponsor. Enrollment in Group MedicareBlue Rx depends on renewal of the plan sponsor's Medicare contract. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions apply. Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year. The formulary or pharmacy network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B premium. 

Wellmark Medicare Supplement plans are not connected with or endorsed by the U.S. government or the federal Medicare program.

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