Complete Blue PPO Signature (PPO)
$0.00 /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 | Gilotrif afatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 2 | Xalkori CRIZOTINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Methylphenidate Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 4 | Acarbose | Brand | Tier 2 | $0.00 | Details |
| 5 | TESTOSTERONE ENANTHATE | Brand | Tier 3 | 0.2% coinsurance | Details |
| 6 | Nicotrol nicotine | Brand | Tier 4 | 0.2% coinsurance | Details |
| 7 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 4 | 0.2% coinsurance | Details |
| 8 | Cabergoline | Brand | Tier 3 | 0.2% coinsurance | Details |
| 9 | REYATAZ ATAZANAVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 11 | Fluvoxamine maleate | Brand | Tier 2 | $0.00 | Details |
| 12 | Omeprazole | Brand | Tier 1 | $0.00 | Details |
| 13 | Lenalidomide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | SCEMBLIX asciminib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | VALPROIC ACID | Brand | Tier 2 | $0.00 | Details |
| 16 | Jardiance Empagliflozin | Brand | Tier 3 | 0.2% coinsurance | Details |
| 17 | Xospata gilteritinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Buspirone Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 19 | Diltiazem Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 20 | Perphenazine perphenazine | Brand | Tier 4 | 0.2% coinsurance | 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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