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Verified against CMS.gov · on April 2026 Plan ID: H3962-022 Cross-check on Medicare.gov →

Capital Blue Cross Essential (HMO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$375.00 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 PODOFILOX Brand Tier 4 0.4% coinsurance Details
2 PREVYMIS LETERMOVIR Brand Tier 5 0.3% coinsurance Details
3 Buspirone Hydrochloride Brand Tier 2 $0.00 Details
4 Nystatin Brand Tier 2 $0.00 Details
5 BOSULIF Bosutinib Brand Tier 5 0.3% coinsurance Details
6 KISQALI ribociclib Brand Tier 5 0.3% coinsurance Details
7 Xalkori CRIZOTINIB Brand Tier 5 0.3% coinsurance Details
8 Mekinist trametinib Brand Tier 5 0.3% coinsurance Details
9 Verzenio abemaciclib Brand Tier 5 0.3% coinsurance Details
10 Fluvoxamine maleate Brand Tier 3 0.2% coinsurance Details
11 Perphenazine perphenazine Brand Tier 4 0.4% coinsurance Details
12 Prograf Tacrolimus Brand Tier 4 0.4% coinsurance Details
13 PREVYMIS LETERMOVIR Brand Tier 5 0.3% coinsurance Details
14 Warfarin Sodium Brand Tier 1 $0.00 Details
15 Dextrose and Sodium Chloride Brand Tier 4 0.4% coinsurance Details
16 Tacrolimus Brand Tier 3 0.2% coinsurance Details
17 Amoxicillin Brand Tier 2 $0.00 Details
18 Levothyroxine Sodium levothyroxine sodium Brand Tier 1 $0.00 Details
19 Venclexta Venetoclax Brand Tier 5 0.3% coinsurance Details
20 NOVOLOG insulin aspart Brand Tier 3 0.2% coinsurance Details

Showing 20 of 893 covered drugs.

Compare this plan against others for your medications Enter your drugs and ZIP to see personalized out-of-pocket costs.
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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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