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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H1666-012 Cross-check on Medicare.gov →

Blue Cross Medicare Advantage Choice Premier (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$450.00 Annual Deductible
928 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 Venclexta Venetoclax Brand Tier 5 0.3% coinsurance Details
2 Dicyclomine Dicyclomine hydrochloride Brand Tier 2 $1.00 Details
3 Cobenfy xanomeline and trospium chloride Brand Tier 5 0.3% coinsurance Details
4 JAYPIRCA pirtobrutinib Brand Tier 5 0.3% coinsurance Details
5 Cefuroxime Brand Tier 4 0.4% coinsurance Details
6 Everolimus Brand Tier 5 0.3% coinsurance Details
7 RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) Brand Tier 1 $0.00 Details
8 Fluphenazine Hydrochloride Brand Tier 4 0.4% coinsurance Details
9 Dupixent Dupilumab Brand Tier 5 0.3% coinsurance Details
10 Gilotrif afatinib Brand Tier 5 0.3% coinsurance Details
11 JANUVIA sitagliptin Brand Tier 3 0.2% coinsurance Details
12 Tacrolimus Brand Tier 4 0.4% coinsurance Details
13 RETEVMO selpercatinib Brand Tier 5 0.3% coinsurance Details
14 Warfarin Sodium Brand Tier 1 $0.00 Details
15 Mefloquine Hydrochloride Brand Tier 3 0.2% coinsurance Details
16 Rufinamide Brand Tier 4 0.4% coinsurance Details
17 Atomoxetine Brand Tier 4 0.4% coinsurance Details
18 COARTEM artemether and lumefantrine Brand Tier 4 0.4% coinsurance Details
19 Fetzima LEVOMILNACIPRAN HYDROCHLORIDE Brand Tier 4 0.4% coinsurance Details
20 FARXIGA DAPAGLIFLOZIN Brand Tier 3 0.2% coinsurance Details

Showing 20 of 928 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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