Freedom Blue PPO Standard (PPO)
$98.20 /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 | Methylphenidate Hydrochloride | Brand | Tier 2 | $13.00 | Details |
| 2 | Venclexta Venetoclax | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Aprepitant aprepitant | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | Cefuroxime | Brand | Tier 2 | $13.00 | Details |
| 5 | Diltiazem Hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 6 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 2 | $13.00 | Details |
| 7 | ISENTRESS RALTEGRAVIR | Brand | Tier 3 | $45.00 | Details |
| 8 | Rufinamide | Brand | Tier 4 | $95.00 | Details |
| 9 | Trumenba meningococcal group B vaccine | Brand | Tier 3 | $45.00 | Details |
| 10 | Amoxicillin | Brand | Tier 1 | $0.00 | Details |
| 11 | Nefazodone Hydrochloride | Brand | Tier 2 | $13.00 | Details |
| 12 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 13 | Nystatin | Brand | Tier 2 | $13.00 | Details |
| 14 | ENTRESTO Sacubitril and Valsartan | Brand | Tier 3 | $45.00 | Details |
| 15 | Loxapine | Brand | Tier 2 | $13.00 | Details |
| 16 | Risperidone | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | Acarbose | Brand | Tier 1 | $0.00 | Details |
| 18 | Depo-SubQ Provera medroxyprogesterone acetate | Brand | Tier 3 | $45.00 | Details |
| 19 | amiloride hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 20 | Buspirone Hydrochloride | Brand | Tier 2 | $13.00 | Details |
Showing 20 of 1,106 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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