Blue Cross Medicare Advantage Classic (PPO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$450.00
Annual Deductible
1,003
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 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 2 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 3 | Morphine Sulfate | Brand | Tier 4 | 0.4% coinsurance | Details |
| 4 | Diltiazem Hydrochloride | Brand | Tier 2 | $1.00 | Details |
| 5 | Clonidine Hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 6 | Baclofen baclofen | Brand | Tier 2 | $1.00 | Details |
| 7 | bexarotene | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Budesonide | Brand | Tier 4 | 0.4% coinsurance | Details |
| 9 | BCG VACCINE BACILLUS CALMETTE-GUERIN SUBSTRAIN TICE LIVE ANTIGEN | Brand | Tier 1 | $0.00 | Details |
| 10 | Gentamicin Sulfate | Brand | Tier 2 | $1.00 | Details |
| 11 | Haloperidol | Brand | Tier 2 | $1.00 | Details |
| 12 | Ciprofloxacin in Dextrose ciprofloxacin | Brand | Tier 4 | 0.4% coinsurance | Details |
| 13 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 14 | Digoxin | Brand | Tier 2 | $1.00 | Details |
| 15 | Prograf Tacrolimus | Brand | Tier 4 | 0.4% coinsurance | Details |
| 16 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.4% coinsurance | Details |
| 17 | Atomoxetine | Brand | Tier 4 | 0.4% coinsurance | Details |
| 18 | Dextrose and Sodium Chloride | Brand | Tier 4 | 0.4% coinsurance | Details |
| 19 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 20 | Jardiance Empagliflozin | Brand | Tier 3 | 0.2% coinsurance | Details |
Showing 20 of 1,003 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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