Capital Blue Cross Complete (PPO)
$49.00 /month
Monthly Premium
$100.00
Annual Deductible
893
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 | Baclofen baclofen | Brand | Tier 3 | 0.2% coinsurance | Details |
| 2 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 3 | 0.2% coinsurance | Details |
| 3 | Diltiazem Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 4 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.4% coinsurance | Details |
| 5 | ZEJULA niraparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | Pilocarpine Hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 7 | Estradiol | Brand | Tier 2 | $0.00 | Details |
| 8 | GARDASIL 9 Human Papillomavirus 9-valent Vaccine, Recombinant | Brand | Tier 3 | 0.2% coinsurance | Details |
| 9 | Cilostazol | Brand | Tier 2 | $0.00 | Details |
| 10 | RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) | Brand | Tier 3 | 0.2% coinsurance | Details |
| 11 | Dicloxacillin Sodium | Brand | Tier 2 | $0.00 | Details |
| 12 | Emtricitabine, Rilpivirine, Tenofovir Disoproxil Fumarate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Clozapine | Brand | Tier 4 | 0.4% coinsurance | Details |
| 14 | Nefazodone Hydrochloride | Brand | Tier 4 | 0.4% coinsurance | Details |
| 15 | Omeprazole | Brand | Tier 1 | $0.00 | Details |
| 16 | PODOFILOX | Brand | Tier 4 | 0.4% coinsurance | Details |
| 17 | PREVYMIS LETERMOVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Buspirone Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 19 | Nystatin | Brand | Tier 2 | $0.00 | Details |
| 20 | BOSULIF Bosutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
Showing 20 of 893 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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