BlueCross Rx Value (PDP)
$139.70 /month
Monthly Premium
$615.00
Annual Deductible
916
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 | Phenobarbital | Brand | Tier 4 | 0.5% coinsurance | Details |
| 2 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.5% coinsurance | Details |
| 3 | Xospata gilteritinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | Cilostazol | Brand | Tier 2 | $17.00 | Details |
| 5 | Warfarin Sodium | Brand | Tier 1 | $12.00 | Details |
| 6 | Methylphenidate Hydrochloride | Brand | Tier 2 | $17.00 | Details |
| 7 | Metoclopramide | Brand | Tier 2 | $17.00 | Details |
| 8 | KISQALI ribociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 9 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $12.00 | Details |
| 10 | Warfarin Sodium | Brand | Tier 1 | $12.00 | Details |
| 11 | Fluvoxamine maleate | Brand | Tier 3 | 0.2% coinsurance | Details |
| 12 | NOVOLOG insulin aspart | Brand | Tier 3 | 0.2% coinsurance | Details |
| 13 | Lorbrena lorlatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Lenalidomide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Cyclosporine Modified Modified Cyclosporine | Brand | Tier 4 | 0.5% coinsurance | Details |
| 16 | Pilocarpine Hydrochloride | Brand | Tier 4 | 0.5% coinsurance | Details |
| 17 | Potassium Chloride potassium chloride | Brand | Tier 2 | $17.00 | Details |
| 18 | Warfarin Sodium | Brand | Tier 1 | $12.00 | Details |
| 19 | Valsartan valsartan | Brand | Tier 6 | $5.00 | Details |
| 20 | KOSELUGO SELUMETINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
Showing 20 of 916 covered drugs.
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