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Verified against CMS.gov · on Oct 1, 2026 Plan ID: H1248-007 Cross-check on Medicare.gov →

Blue adVantage Liberty (PPO)

Plan Year 2026
$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 Levothyroxine Sodium levothyroxine sodium Brand Tier 1 $0.00 Details
2 TRUQAP capivasertib Brand Tier 5 0.3% coinsurance Details
3 Ibrance palbociclib Brand Tier 5 0.3% coinsurance Details
4 Perphenazine perphenazine Brand Tier 4 0.5% coinsurance Details
5 NOVOLOG insulin aspart Brand Tier 3 $45.00 Details
6 VAQTA hepatitis A vaccine, inactivated Brand Tier 1 $0.00 Details
7 CRESEMBA isavuconazonium sulfate Brand Tier 5 0.3% coinsurance Details
8 Nitroglycerin nitroglycerin Brand Tier 2 $12.00 Details
9 Trifluoperazine Hydrochloride trifluoperazine hydrochloride Brand Tier 3 $45.00 Details
10 Xalkori CRIZOTINIB Brand Tier 5 0.3% coinsurance Details
11 KOSELUGO SELUMETINIB Brand Tier 5 0.3% coinsurance Details
12 COARTEM artemether and lumefantrine Brand Tier 4 0.5% coinsurance Details
13 Tacrolimus Brand Tier 3 $45.00 Details
14 RotaTeq Rotavirus Vaccine, Live, Oral, Pentavalent Brand Tier 3 $45.00 Details
15 Clozapine Brand Tier 4 0.5% coinsurance Details
16 TicoVac Tick-Borne Encephalitis Vaccine Brand Tier 3 $45.00 Details
17 Ciprofloxacin Brand Tier 2 $12.00 Details
18 Lenalidomide Brand Tier 5 0.3% coinsurance Details
19 Lynparza olaparib Brand Tier 5 0.3% coinsurance Details
20 HERNEXEOS zongertinib Brand Tier 5 0.3% coinsurance Details

Showing 20 of 960 covered drugs.

Compare this plan against others for your medications Enter your drugs and ZIP to see personalized out-of-pocket costs.
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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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