Blue adVantage Classic (HMO-POS)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$300.00
Annual Deductible
960
Drugs Covered
1
States Served
Top Covered Drugs
Most popular medications covered by this plan, ordered by national search frequency. Click any drug to see exact copay, restrictions, and alternatives.
| # | Drug Name | Type | Tier | 30-Day Copay | |
|---|---|---|---|---|---|
| 1 | Nortriptyline Hydrochloride | Brand | Tier 2 | $12.00 | Details |
| 2 | Doxepin Hydrochloride doxepin hydrochloride | Brand | Tier 4 | 0.5% coinsurance | Details |
| 3 | Pilocarpine Hydrochloride | Brand | Tier 4 | 0.5% coinsurance | Details |
| 4 | Depo-SubQ Provera medroxyprogesterone acetate | Brand | Tier 3 | $45.00 | Details |
| 5 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 6 | Medroxyprogesterone Acetate | Brand | Tier 2 | $12.00 | Details |
| 7 | Gentamicin Sulfate | Brand | Tier 3 | $45.00 | Details |
| 8 | Rufinamide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 9 | Ibrance palbociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | Pyridostigmine Bromide PYRIDOSTIGMINE BROMIDE | Brand | Tier 3 | $45.00 | Details |
| 11 | Diltiazem Hydrochloride | Brand | Tier 2 | $12.00 | Details |
| 12 | Vizimpro dacomitinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Phenobarbital | Brand | Tier 3 | $45.00 | Details |
| 14 | SCEMBLIX asciminib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Combivent Respimat ipratropium bromide and albuterol | Brand | Tier 3 | $45.00 | Details |
| 16 | Augtyro repotrectinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | Talzenna talazoparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Loxapine | Brand | Tier 2 | $12.00 | Details |
| 19 | Venlafaxine Hydrochloride | Brand | Tier 2 | $12.00 | Details |
| 20 | Everolimus | Brand | Tier 5 | 0.3% coinsurance | Details |
Showing 20 of 960 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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