Blue Cross Medicare Advantage Classic (PPO)
$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 | Amoxicillin | Brand | Tier 2 | $1.00 | Details |
| 2 | Bromocriptine mesylate | Brand | Tier 4 | 0.4% coinsurance | Details |
| 3 | Loxapine | Brand | Tier 3 | 0.2% coinsurance | Details |
| 4 | Augtyro repotrectinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | SCEMBLIX asciminib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | Augtyro repotrectinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 4 | 0.4% coinsurance | Details |
| 8 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 9 | Erlotinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | Acamprosate Calcium acamprosate calcium enteric-coated | Brand | Tier 4 | 0.4% coinsurance | Details |
| 11 | Ibrance palbociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | Xtandi enzalutamide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Fiasp insulin aspart injection | Brand | Tier 3 | 0.2% coinsurance | Details |
| 14 | HYDROCODONE BITARTRATE AND ACETAMINOPHEN | Brand | Tier 3 | 0.2% coinsurance | Details |
| 15 | Mekinist trametinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Mekinist trametinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | Pyridostigmine Bromide PYRIDOSTIGMINE BROMIDE | Brand | Tier 3 | 0.2% coinsurance | Details |
| 18 | ISENTRESS RALTEGRAVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Nitroglycerin nitroglycerin | Brand | Tier 2 | $1.00 | Details |
| 20 | ZYKADIA ceritinib | Brand | Tier 5 | 0.3% coinsurance | Details |
Showing 20 of 928 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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