Medicare HMO Blue PlusRx (HMO)
$54.60 /month
Monthly Premium
$200.00
Annual Deductible
967
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 2 | $5.00 | Details |
| 2 | Augtyro repotrectinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Ofev nintedanib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | Nicotrol nicotine | Brand | Tier 4 | $95.00 | Details |
| 6 | Cobenfy xanomeline and trospium chloride | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Morphine Sulfate | Brand | Tier 2 | $5.00 | Details |
| 8 | Metoprolol Tartrate metoprolol tartrate | Brand | Tier 1 | $0.00 | Details |
| 9 | BOSULIF Bosutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | ISENTRESS RALTEGRAVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | Prograf Tacrolimus | Brand | Tier 4 | $95.00 | Details |
| 12 | Nitroglycerin nitroglycerin | Brand | Tier 2 | $5.00 | Details |
| 13 | Estradiol | Brand | Tier 2 | $5.00 | Details |
| 14 | Tafinlar dabrafenib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Medroxyprogesterone Acetate | Brand | Tier 1 | $0.00 | Details |
| 16 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 2 | $5.00 | Details |
| 17 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 18 | Mifepristone | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Phenobarbital | Brand | Tier 3 | $42.00 | Details |
| 20 | Clozapine | Brand | Tier 2 | $5.00 | Details |
Showing 20 of 967 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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