Freedom Blue PPO Select (PPO)
$115.70 /month
Monthly Premium
$0.00
Annual Deductible
1,106
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 | Depo-SubQ Provera medroxyprogesterone acetate | Brand | Tier 3 | $45.00 | Details |
| 2 | amiloride hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 3 | Buspirone Hydrochloride | Brand | Tier 2 | $13.00 | Details |
| 4 | Valsartan valsartan | Brand | Tier 1 | $0.00 | Details |
| 5 | Tafinlar dabrafenib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Tacrolimus | Brand | Tier 2 | $13.00 | Details |
| 8 | Isosorbide Dinitrate | Brand | Tier 2 | $13.00 | Details |
| 9 | Paxlovid nirmatrelvir and ritonavir | Brand | Tier 3 | $45.00 | Details |
| 10 | Ibrance palbociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | Methotrexate | Brand | Tier 2 | $13.00 | Details |
| 12 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 13 | Nitroglycerin nitroglycerin | Brand | Tier 2 | $13.00 | Details |
| 14 | Potassium Chloride | Brand | Tier 1 | $0.00 | Details |
| 15 | Chlorpromazine Hydrochloride | Brand | Tier 4 | $95.00 | Details |
| 16 | Amoxicillin | Brand | Tier 1 | $0.00 | Details |
| 17 | Lenalidomide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Ciprofloxacin | Brand | Tier 1 | $0.00 | Details |
| 19 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | $95.00 | Details |
| 20 | RETEVMO selpercatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
Showing 20 of 1,106 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
Find Your Best Medicare Plan for 2026
Compare plans side-by-side with the help of a licensed Medicare specialist. Free service — no obligation.
Compare Medicare Plans Free- ✓ Compare all plans in your area
- ✓ Licensed agents available 7 days a week
- ✓ No cost, no obligation
We may receive a referral fee if you enroll through this link. DrugCovered is not affiliated with Medicare or any government agency. Plan availability and costs vary by ZIP code. Not all plans may be available in your area.