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 | Phenobarbital | Brand | Tier 2 | $11.00 | Details |
| 2 | Lenalidomide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Sodium Chloride | Brand | Tier 2 | $11.00 | Details |
| 4 | Ibrance palbociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | ISENTRESS RALTEGRAVIR | Brand | Tier 3 | $45.00 | Details |
| 6 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 3 | $45.00 | Details |
| 7 | Emtricitabine, Rilpivirine, Tenofovir Disoproxil Fumarate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | amiloride hydrochloride | Brand | Tier 2 | $11.00 | Details |
| 9 | Augtyro repotrectinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | ENTRESTO Sacubitril and Valsartan | Brand | Tier 3 | $45.00 | Details |
| 11 | Nefazodone Hydrochloride | Brand | Tier 4 | $100.00 | Details |
| 12 | Daurismo glasdegib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Ibrance palbociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Amoxicillin | Brand | Tier 1 | $0.00 | Details |
| 15 | CRESEMBA isavuconazonium sulfate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Linzess linaclotide | Brand | Tier 3 | $45.00 | Details |
| 17 | Fludrocortisone Acetate FLUDROCORTISONE ACETATE | Brand | Tier 2 | $11.00 | Details |
| 18 | Vigabatrin | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Dicyclomine Dicyclomine hydrochloride | Brand | Tier 2 | $11.00 | Details |
| 20 | Tafinlar dabrafenib | Brand | Tier 5 | 0.3% 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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