Blue Cross Medicare Advantage Dental Premier (PPO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00
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 | Lorbrena lorlatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 2 | PedvaxHIB Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate) | Brand | Tier 1 | $0.00 | Details |
| 3 | Priftin rifapentine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 4 | KOSELUGO SELUMETINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | Gentamicin Sulfate | Brand | Tier 3 | 0.2% coinsurance | Details |
| 6 | ISENTRESS RALTEGRAVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Trifluoperazine Hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 8 | Amoxicillin | Brand | Tier 2 | $0.00 | Details |
| 9 | Bromocriptine mesylate | Brand | Tier 4 | 0.3% coinsurance | Details |
| 10 | Loxapine | Brand | Tier 3 | 0.2% coinsurance | Details |
| 11 | Augtyro repotrectinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | SCEMBLIX asciminib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Augtyro repotrectinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 4 | 0.3% coinsurance | Details |
| 15 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 16 | Erlotinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | Acamprosate Calcium acamprosate calcium enteric-coated | Brand | Tier 4 | 0.3% coinsurance | Details |
| 18 | Ibrance palbociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Xtandi enzalutamide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | Fiasp insulin aspart injection | Brand | Tier 3 | 0.2% 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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