BlueCross Total (PPO)
$29.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$400.00
Annual Deductible
1,003
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 | Paxlovid nirmatrelvir and ritonavir | Brand | Tier 3 | 0.3% coinsurance | Details |
| 2 | Nitroglycerin nitroglycerin | Brand | Tier 2 | $5.00 | Details |
| 3 | Ceftriaxone Sodium | Brand | Tier 3 | 0.3% coinsurance | Details |
| 4 | Prednisone | Brand | Tier 1 | $0.00 | Details |
| 5 | RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) | Brand | Tier 1 | $0.00 | Details |
| 6 | Xalkori CRIZOTINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | 0.3% coinsurance | Details |
| 8 | Pilocarpine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 9 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 10 | Buspirone Hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 11 | Buprenorphine | Brand | Tier 2 | $5.00 | Details |
| 12 | Clonidine Hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 13 | ISENTRESS RALTEGRAVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Teflaro ceftaroline fosamil | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Loxapine | Brand | Tier 2 | $5.00 | Details |
| 16 | COARTEM artemether and lumefantrine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 17 | Balsalazide Disodium | Brand | Tier 4 | 0.3% coinsurance | Details |
| 18 | Ibrance palbociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | RotaTeq Rotavirus Vaccine, Live, Oral, Pentavalent | Brand | Tier 3 | 0.3% coinsurance | Details |
| 20 | PIQRAY alpelisib | Brand | Tier 5 | 0.3% coinsurance | Details |
Showing 20 of 1,003 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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