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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H1666-020 Cross-check on Medicare.gov →

Blue Cross Medicare Advantage Optimum (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$300.00 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 Warfarin Sodium Brand Tier 1 $0.00 Details
2 Efavirenz, Emtricitabine and Tenofovir Disoproxil Fumarate Brand Tier 4 0.4% coinsurance Details
3 Nystatin Brand Tier 2 $1.00 Details
4 Methylphenidate Hydrochloride Brand Tier 3 0.2% coinsurance Details
5 Mekinist trametinib Brand Tier 5 0.3% coinsurance Details
6 ZEJULA niraparib Brand Tier 5 0.3% coinsurance Details
7 Primaquine Phosphate Brand Tier 4 0.4% coinsurance Details
8 Dexamethasone Brand Tier 2 $1.00 Details
9 Medroxyprogesterone Acetate Brand Tier 1 $0.00 Details
10 Warfarin Sodium Brand Tier 1 $0.00 Details
11 Enoxaparin Sodium Enoxaparin sodium Brand Tier 4 0.4% coinsurance Details
12 Gilotrif afatinib Brand Tier 5 0.3% coinsurance Details
13 Chlorpromazine Hydrochloride Brand Tier 4 0.4% coinsurance Details
14 Aprepitant aprepitant Brand Tier 4 0.4% coinsurance Details
15 Prednisone Brand Tier 1 $0.00 Details
16 PedvaxHIB Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate) Brand Tier 1 $0.00 Details
17 Everolimus Brand Tier 4 0.4% coinsurance Details
18 Heparin Sodium Brand Tier 3 0.2% coinsurance Details
19 Diazepam Brand Tier 2 $1.00 Details
20 Fetzima LEVOMILNACIPRAN HYDROCHLORIDE Brand Tier 4 0.4% coinsurance Details

Showing 20 of 1,003 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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