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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H3916-018 Cross-check on Medicare.gov →

Freedom Blue PPO ValueRx (PPO)

Plan Year 2026
$44.00 /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 CRESEMBA isavuconazonium sulfate Brand Tier 5 0.3% coinsurance Details
2 Linzess linaclotide Brand Tier 3 $45.00 Details
3 Fludrocortisone Acetate FLUDROCORTISONE ACETATE Brand Tier 2 $13.00 Details
4 Vigabatrin Brand Tier 5 0.3% coinsurance Details
5 Dicyclomine Dicyclomine hydrochloride Brand Tier 2 $13.00 Details
6 Tafinlar dabrafenib Brand Tier 5 0.3% coinsurance Details
7 Warfarin Sodium Brand Tier 1 $0.00 Details
8 Cobenfy xanomeline and trospium chloride Brand Tier 5 0.3% coinsurance Details
9 Paxlovid nirmatrelvir and ritonavir Brand Tier 3 $45.00 Details
10 Chlorpromazine Hydrochloride Brand Tier 4 0.3% coinsurance Details
11 Loxapine Brand Tier 2 $13.00 Details
12 Ciprofloxacin Brand Tier 1 $0.00 Details
13 Warfarin Sodium Brand Tier 1 $0.00 Details
14 Thioridazine Hydrochloride thioridazine hydrochloride Brand Tier 2 $13.00 Details
15 Buspirone Hydrochloride Brand Tier 2 $13.00 Details
16 Nystatin Brand Tier 2 $13.00 Details
17 Cefuroxime Brand Tier 3 $45.00 Details
18 Verzenio abemaciclib Brand Tier 5 0.3% coinsurance Details
19 Gilotrif afatinib Brand Tier 5 0.3% coinsurance Details
20 Xalkori CRIZOTINIB Brand Tier 5 0.3% coinsurance Details

Showing 20 of 970 covered drugs.

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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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