BlueAdvantage Ruby (PPO)
$89.00 /month
Monthly Premium
$250.00
Annual Deductible
998
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 | BCG VACCINE BACILLUS CALMETTE-GUERIN SUBSTRAIN TICE LIVE ANTIGEN | Brand | Tier 3 | $28.00 | Details |
| 2 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.5% coinsurance | Details |
| 3 | Phenobarbital | Brand | Tier 4 | 0.5% coinsurance | Details |
| 4 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 4 | 0.5% coinsurance | Details |
| 5 | TicoVac Tick-Borne Encephalitis Vaccine | Brand | Tier 3 | $28.00 | Details |
| 6 | SOMAVERT pegvisomant | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Calcipotriene | Brand | Tier 4 | 0.5% coinsurance | Details |
| 8 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 9 | Vizimpro dacomitinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | NOVOLOG insulin aspart | Brand | Tier 3 | $28.00 | Details |
| 11 | KOSELUGO SELUMETINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | Prograf Tacrolimus | Brand | Tier 4 | 0.5% coinsurance | Details |
| 13 | Pilocarpine Hydrochloride | Brand | Tier 2 | $5.00 | Details |
| 14 | Buspirone Hydrochloride | Brand | Tier 2 | $5.00 | Details |
| 15 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 4 | 0.5% coinsurance | Details |
| 16 | Jardiance Empagliflozin | Brand | Tier 3 | $28.00 | Details |
| 17 | Buspirone Hydrochloride | Brand | Tier 2 | $5.00 | Details |
| 18 | Isosorbide Dinitrate | Brand | Tier 1 | $0.00 | Details |
| 19 | FENTANYL | Brand | Tier 4 | 0.5% coinsurance | Details |
| 20 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 4 | 0.5% coinsurance | Details |
Showing 20 of 998 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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