Complete Blue PPO Distinct (PPO)
$1.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00
Annual Deductible
970
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 | 0.2% coinsurance | Details |
| 2 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 3 | Loxapine | Brand | Tier 2 | $0.00 | Details |
| 4 | Ciprofloxacin | Brand | Tier 1 | $0.00 | Details |
| 5 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 6 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 7 | Buspirone Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 8 | Nystatin | Brand | Tier 2 | $0.00 | Details |
| 9 | Cefuroxime | Brand | Tier 3 | 0.2% coinsurance | Details |
| 10 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | Gilotrif afatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | Xalkori CRIZOTINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Methylphenidate Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 14 | Acarbose | Brand | Tier 2 | $0.00 | Details |
| 15 | TESTOSTERONE ENANTHATE | Brand | Tier 3 | 0.2% coinsurance | Details |
| 16 | Nicotrol nicotine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 17 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 4 | 0.3% coinsurance | Details |
| 18 | Cabergoline | Brand | Tier 3 | 0.2% coinsurance | Details |
| 19 | REYATAZ ATAZANAVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
Showing 20 of 970 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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