Medicare BlueBalanced (PPO)
$55.00 /month
Monthly Premium
$615.00
Annual Deductible
1,122
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 | Pioglitazone | Brand | Tier 1 | $3.00 | Details |
| 2 | POSACONAZOLE Posaconazole | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | PIQRAY alpelisib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | Rufinamide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | Talzenna talazoparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | Buspirone Hydrochloride | Brand | Tier 2 | $15.00 | Details |
| 7 | Mercaptopurine | Brand | Tier 2 | $15.00 | Details |
| 8 | Nitroglycerin nitroglycerin | Brand | Tier 2 | $15.00 | Details |
| 9 | Buspirone Hydrochloride | Brand | Tier 2 | $15.00 | Details |
| 10 | WELIREG belzutifan | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | Abrysvo Respiratory Syncytial Virus Vaccine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 12 | Cefuroxime | Brand | Tier 4 | 0.3% coinsurance | Details |
| 13 | SOMAVERT pegvisomant | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Omeprazole | Brand | Tier 3 | 0.2% coinsurance | Details |
| 15 | Dexamethasone | Brand | Tier 4 | 0.3% coinsurance | Details |
| 16 | Diazepam | Brand | Tier 2 | $15.00 | Details |
| 17 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 18 | Lynparza olaparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Prograf Tacrolimus | Brand | Tier 4 | 0.3% coinsurance | Details |
| 20 | Amoxicillin | Brand | Tier 2 | $15.00 | Details |
Showing 20 of 1,122 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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