Capital Blue Cross Essential (HMO)
$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 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 2 | Vizimpro dacomitinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | TAGRISSO osimertinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | Lorbrena lorlatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | Ipratropium Bromide | Brand | Tier 2 | $0.00 | Details |
| 6 | Venlafaxine Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 7 | BOSULIF Bosutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 9 | Gentamicin Sulfate | Brand | Tier 3 | 0.2% coinsurance | Details |
| 10 | Baclofen | Brand | Tier 2 | $0.00 | Details |
| 11 | Phenobarbital | Brand | Tier 2 | $0.00 | Details |
| 12 | Leucovorin Calcium | Brand | Tier 3 | 0.2% coinsurance | Details |
| 13 | Trumenba meningococcal group B vaccine | Brand | Tier 3 | 0.2% coinsurance | Details |
| 14 | PIQRAY alpelisib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Estradiol | Brand | Tier 2 | $0.00 | Details |
| 16 | Amoxapine | Brand | Tier 4 | 0.4% coinsurance | Details |
| 17 | Fludrocortisone Acetate FLUDROCORTISONE ACETATE | Brand | Tier 2 | $0.00 | Details |
| 18 | Clonidine Hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 19 | Mefloquine Hydrochloride | Brand | Tier 4 | 0.4% coinsurance | Details |
| 20 | Tiagabine Hydrochloride | Brand | Tier 4 | 0.4% 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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