Freedom Blue PPO Standard (PPO)
$65.20 /month
Monthly Premium
$0.00
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 | Ampicillin and Sulbactam | Brand | Tier 4 | $100.00 | Details |
| 2 | Imatinib Mesylate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Mercaptopurine | Brand | Tier 2 | $11.00 | Details |
| 4 | RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) | Brand | Tier 3 | $45.00 | Details |
| 5 | Atomoxetine | Brand | Tier 3 | $45.00 | Details |
| 6 | Morphine Sulfate | Brand | Tier 2 | $11.00 | Details |
| 7 | FARXIGA DAPAGLIFLOZIN | Brand | Tier 3 | $45.00 | Details |
| 8 | Lorbrena lorlatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 9 | Phenobarbital | Brand | Tier 2 | $11.00 | Details |
| 10 | ZYKADIA ceritinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | Tiagabine Hydrochloride | Brand | Tier 4 | $100.00 | Details |
| 12 | Venclexta Venetoclax | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Medroxyprogesterone Acetate | Brand | Tier 2 | $11.00 | Details |
| 14 | Diltiazem Hydrochloride | Brand | Tier 2 | $11.00 | Details |
| 15 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 16 | Loxapine | Brand | Tier 2 | $11.00 | Details |
| 17 | bexarotene | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Erlotinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | Haloperidol | Brand | Tier 2 | $11.00 | 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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