BlueCross Total Value (PPO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00
Annual Deductible
962
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 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 2 | Cyclosporine Modified Modified Cyclosporine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 3 | Nystatin | Brand | Tier 2 | $5.00 | Details |
| 4 | Dupixent Dupilumab | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | SCEMBLIX asciminib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | Cefuroxime | Brand | Tier 4 | 0.3% coinsurance | Details |
| 7 | Dexamethasone | Brand | Tier 2 | $5.00 | Details |
| 8 | GARDASIL 9 Human Papillomavirus 9-valent Vaccine, Recombinant | Brand | Tier 1 | $0.00 | Details |
| 9 | Ibrance palbociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | Diazepam | Brand | Tier 2 | $5.00 | Details |
| 11 | Venclexta Venetoclax | Brand | Tier 4 | 0.3% coinsurance | Details |
| 12 | Valsartan valsartan | Brand | Tier 6 | $0.00 | Details |
| 13 | Haloperidol | Brand | Tier 2 | $5.00 | Details |
| 14 | Atomoxetine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 15 | Tacrolimus | Brand | Tier 4 | 0.3% coinsurance | Details |
| 16 | Fiasp insulin aspart injection | Brand | Tier 3 | 0.2% coinsurance | Details |
| 17 | TRUQAP capivasertib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Lorbrena lorlatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | TRUQAP capivasertib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | Risperidone | Brand | Tier 5 | 0.3% coinsurance | Details |
Showing 20 of 962 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
Find Your Best Medicare Plan for 2026
Compare plans side-by-side with the help of a licensed Medicare specialist. Free service — no obligation.
Compare Medicare Plans Free- ✓ Compare all plans in your area
- ✓ Licensed agents available 7 days a week
- ✓ No cost, no obligation
We may receive a referral fee if you enroll through this link. DrugCovered is not affiliated with Medicare or any government agency. Plan availability and costs vary by ZIP code. Not all plans may be available in your area.