Complete Blue PPO Distinct (PPO)
$48.00 /month
Monthly Premium
$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 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 3 | $0.00 | Details |
| 2 | Emtricitabine, Rilpivirine, Tenofovir Disoproxil Fumarate | Brand | Tier 5 | $0.00 | Details |
| 3 | amiloride hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 4 | Augtyro repotrectinib | Brand | Tier 5 | $0.00 | Details |
| 5 | ENTRESTO Sacubitril and Valsartan | Brand | Tier 3 | $0.00 | Details |
| 6 | Nefazodone Hydrochloride | Brand | Tier 4 | $0.00 | Details |
| 7 | Daurismo glasdegib | Brand | Tier 5 | $0.00 | Details |
| 8 | Ibrance palbociclib | Brand | Tier 5 | $0.00 | Details |
| 9 | Amoxicillin | Brand | Tier 1 | $0.00 | Details |
| 10 | CRESEMBA isavuconazonium sulfate | Brand | Tier 5 | $0.00 | Details |
| 11 | Linzess linaclotide | Brand | Tier 3 | $0.00 | Details |
| 12 | Fludrocortisone Acetate FLUDROCORTISONE ACETATE | Brand | Tier 2 | $0.00 | Details |
| 13 | Vigabatrin | Brand | Tier 5 | $0.00 | Details |
| 14 | Dicyclomine Dicyclomine hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 15 | Tafinlar dabrafenib | Brand | Tier 5 | $0.00 | Details |
| 16 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 17 | Cobenfy xanomeline and trospium chloride | Brand | Tier 5 | $0.00 | Details |
| 18 | Paxlovid nirmatrelvir and ritonavir | Brand | Tier 3 | $0.00 | Details |
| 19 | Chlorpromazine Hydrochloride | Brand | Tier 4 | $0.00 | Details |
| 20 | Loxapine | Brand | Tier 2 | $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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