Blue Cross MedicareRx Basic (PDP)
$104.70 /month
Monthly Premium
$615.00
Annual Deductible
878
Drugs Covered
0
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 | PIQRAY alpelisib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 2 | Augtyro repotrectinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 4 | ISENTRESS RALTEGRAVIR | Brand | Tier 4 | 0.4% coinsurance | Details |
| 5 | Isoniazid | Brand | Tier 2 | $5.00 | Details |
| 6 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 1 | $0.00 | Details |
| 7 | Ciprofloxacin | Brand | Tier 2 | $5.00 | Details |
| 8 | CRESEMBA isavuconazonium sulfate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 9 | Ciprofloxacin | Brand | Tier 2 | $5.00 | Details |
| 10 | Loxapine | Brand | Tier 3 | 0.2% coinsurance | Details |
| 11 | WELIREG belzutifan | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | Mekinist trametinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Fiasp insulin aspart injection | Brand | Tier 3 | 0.2% coinsurance | Details |
| 14 | Fluphenazine Hydrochloride | Brand | Tier 4 | 0.4% coinsurance | Details |
| 15 | ELIQUIS 30-Day Starter Pack 30-Day Starter Pack apixaban | Brand | Tier 3 | 0.2% coinsurance | Details |
| 16 | Dexamethasone | Brand | Tier 4 | 0.4% coinsurance | Details |
| 17 | Diazepam | Brand | Tier 3 | 0.2% coinsurance | Details |
| 18 | RETEVMO selpercatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Venclexta Venetoclax | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | Dicyclomine Hydrochloride | Brand | Tier 4 | 0.4% coinsurance | Details |
Showing 20 of 878 covered drugs.
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