Blue Cross MedicareRx Value (PDP)
$111.30 /month
Monthly Premium
$615.00
Annual Deductible
922
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 | Clozapine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 2 | Phenobarbital | Brand | Tier 2 | $4.00 | Details |
| 3 | Lorbrena lorlatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | Loxapine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 5 | Rufinamide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | Acarbose | Brand | Tier 3 | 0.1% coinsurance | Details |
| 7 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 8 | Amoxicillin and Clavulanate Potassium | Brand | Tier 4 | 0.3% coinsurance | Details |
| 9 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 10 | FARXIGA DAPAGLIFLOZIN | Brand | Tier 3 | 0.1% coinsurance | Details |
| 11 | Xalkori CRIZOTINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | SOMAVERT pegvisomant | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Vizimpro dacomitinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Venclexta Venetoclax | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Lynparza olaparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Dicyclomine Dicyclomine hydrochloride | Brand | Tier 2 | $4.00 | Details |
| 17 | BOSULIF Bosutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Chlorhexidine Gluconate | Brand | Tier 1 | $0.00 | Details |
| 19 | Prednisone | Brand | Tier 2 | $4.00 | Details |
| 20 | RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) | Brand | Tier 1 | $0.00 | Details |
Showing 20 of 922 covered drugs.
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