Medicare PPO Blue PlusRx (PPO)
$124.40 /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 | ZYKADIA ceritinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 2 | VALPROIC ACID | Brand | Tier 2 | $5.00 | Details |
| 3 | Cilostazol | Brand | Tier 1 | $0.00 | Details |
| 4 | Buspirone Hydrochloride | Brand | Tier 2 | $5.00 | Details |
| 5 | Lupron Depot leuprolide acetate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | KISQALI ribociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Amoxapine | Brand | Tier 3 | $42.00 | Details |
| 8 | Ciprofloxacin | Brand | Tier 1 | $0.00 | Details |
| 9 | JANUVIA sitagliptin | Brand | Tier 3 | $42.00 | Details |
| 10 | Leucovorin Calcium | Brand | Tier 2 | $5.00 | Details |
| 11 | Haloperidol | Brand | Tier 2 | $5.00 | Details |
| 12 | Pilocarpine Hydrochloride | Brand | Tier 2 | $5.00 | Details |
| 13 | Amoxicillin | Brand | Tier 1 | $0.00 | Details |
| 14 | Metoclopramide | Brand | Tier 1 | $0.00 | Details |
| 15 | Lenalidomide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Trifluoperazine Hydrochloride trifluoperazine hydrochloride | Brand | Tier 2 | $5.00 | Details |
| 17 | Cyclosporine Modified Modified Cyclosporine | Brand | Tier 2 | $5.00 | Details |
| 18 | Nystatin | Brand | Tier 2 | $5.00 | Details |
| 19 | TABRECTA capmatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | Levothyroxine Sodium levothyroxine sodium | 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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