Blue Medicare Choice (HMO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00
Annual Deductible
1,002
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 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | 0.3% coinsurance | Details |
| 2 | Gilotrif afatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Trumenba meningococcal group B vaccine | Brand | Tier 6 | $0.00 | Details |
| 4 | Haloperidol | Brand | Tier 2 | $4.00 | Details |
| 5 | Amoxicillin and Clavulanate Potassium | Brand | Tier 2 | $4.00 | Details |
| 6 | Phenobarbital | Brand | Tier 2 | $4.00 | Details |
| 7 | M-M-R II measles, mumps, and rubella virus vaccine live | Brand | Tier 6 | $0.00 | Details |
| 8 | Prograf Tacrolimus | Brand | Tier 4 | 0.3% coinsurance | Details |
| 9 | Xospata gilteritinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | SCEMBLIX asciminib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | Cilostazol | Brand | Tier 2 | $4.00 | Details |
| 12 | Xtandi enzalutamide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Fiasp insulin aspart injection | Brand | Tier 3 | 0.3% coinsurance | Details |
| 14 | ZEJULA niraparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Diltiazem Hydrochloride | Brand | Tier 2 | $4.00 | Details |
| 17 | Venlafaxine Hydrochloride | Brand | Tier 2 | $4.00 | Details |
| 18 | Potassium Chloride potassium chloride | Brand | Tier 2 | $4.00 | Details |
| 19 | Acarbose | Brand | Tier 2 | $4.00 | Details |
| 20 | Gentamicin Sulfate | Brand | Tier 3 | 0.3% coinsurance | Details |
Showing 20 of 1,002 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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