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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H3335-061 Cross-check on Medicare.gov →

Medicare BlueVital (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$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 Enoxaparin Sodium Enoxaparin sodium Brand Tier 4 0.3% coinsurance Details
2 TRUQAP capivasertib Brand Tier 5 0.3% coinsurance Details
3 Cabergoline Brand Tier 2 $15.00 Details
4 Gilotrif afatinib Brand Tier 5 0.3% coinsurance Details
5 Pyridostigmine Bromide PYRIDOSTIGMINE BROMIDE Brand Tier 2 $15.00 Details
6 Fludrocortisone Acetate FLUDROCORTISONE ACETATE Brand Tier 2 $15.00 Details
7 Levothyroxine Sodium levothyroxine sodium Brand Tier 1 $5.00 Details
8 Warfarin Sodium Brand Tier 1 $5.00 Details
9 Venclexta Venetoclax Brand Tier 5 0.3% coinsurance Details
10 Verzenio abemaciclib Brand Tier 5 0.3% coinsurance Details
11 Sulfasalazine Brand Tier 2 $15.00 Details
12 TAGRISSO osimertinib Brand Tier 5 0.3% coinsurance Details
13 Thioridazine Hydrochloride thioridazine hydrochloride Brand Tier 2 $15.00 Details
14 ZEJULA niraparib Brand Tier 5 0.3% coinsurance Details
15 BOSULIF Bosutinib Brand Tier 5 0.3% coinsurance Details
16 Risperidone Brand Tier 5 0.3% coinsurance Details
17 Augtyro repotrectinib Brand Tier 5 0.3% coinsurance Details
18 KISQALI ribociclib Brand Tier 5 0.3% coinsurance Details
19 Chlorhexidine Gluconate Brand Tier 2 $15.00 Details
20 VAQTA hepatitis A vaccine, inactivated Brand Tier 3 0.2% coinsurance Details

Showing 20 of 1,122 covered drugs.

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States Served (1)

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

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