Blue Cross Medicare Advantage Value (HMO)
$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 | Venlafaxine Hydrochloride | Brand | Tier 2 | $1.00 | Details |
| 2 | Haloperidol | Brand | Tier 3 | 0.2% coinsurance | Details |
| 3 | KISQALI ribociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | Xtandi enzalutamide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | Trifluoperazine Hydrochloride trifluoperazine hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 6 | Leucovorin Calcium | Brand | Tier 3 | 0.2% coinsurance | Details |
| 7 | RotaTeq Rotavirus Vaccine, Live, Oral, Pentavalent | Brand | Tier 1 | $0.00 | Details |
| 8 | Perphenazine perphenazine | Brand | Tier 4 | 0.4% coinsurance | Details |
| 9 | Dexamethasone | Brand | Tier 2 | $1.00 | Details |
| 10 | PREVYMIS LETERMOVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | Loxapine | Brand | Tier 3 | 0.2% coinsurance | Details |
| 12 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 13 | Acarbose | Brand | Tier 2 | $1.00 | Details |
| 14 | Risperidone | Brand | Tier 4 | 0.4% coinsurance | Details |
| 15 | Budesonide | Brand | Tier 4 | 0.4% coinsurance | Details |
| 16 | Venclexta Venetoclax | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | Dicyclomine Dicyclomine hydrochloride | Brand | Tier 2 | $1.00 | Details |
| 18 | Cobenfy xanomeline and trospium chloride | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | JAYPIRCA pirtobrutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | Cefuroxime | Brand | Tier 4 | 0.4% 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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