Blue Cross Medicare Advantage Classic (PPO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00
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 | Prednisone | Brand | Tier 1 | $0.00 | Details |
| 2 | PedvaxHIB Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate) | Brand | Tier 1 | $0.00 | Details |
| 3 | Everolimus | Brand | Tier 4 | 0.4% coinsurance | Details |
| 4 | Heparin Sodium | Brand | Tier 3 | 0.2% coinsurance | Details |
| 5 | Diazepam | Brand | Tier 2 | $1.00 | Details |
| 6 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | 0.4% coinsurance | Details |
| 7 | Risperidone | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Loxapine | Brand | Tier 2 | $1.00 | Details |
| 9 | Metoclopramide | Brand | Tier 1 | $0.00 | Details |
| 10 | Vigabatrin | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | Prochlorperazine | Brand | Tier 4 | 0.4% coinsurance | Details |
| 12 | Cobenfy xanomeline and trospium chloride | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Morphine Sulfate | Brand | Tier 4 | 0.4% coinsurance | Details |
| 14 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 4 | 0.4% coinsurance | Details |
| 15 | Mekinist trametinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Emtricitabine and Tenofovir Disoproxil Fumarate | Brand | Tier 4 | 0.4% coinsurance | Details |
| 17 | BOSULIF Bosutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Phenobarbital Oral Solution Phenobarbital Oral | Brand | Tier 4 | 0.4% coinsurance | Details |
| 19 | Nortriptyline Hydrochloride | Brand | Tier 4 | 0.4% coinsurance | Details |
| 20 | Scopolamine scopolamine | Brand | Tier 4 | 0.4% 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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