MedicareBlue Rx Standard (PDP)
$101.00 /month
Monthly Premium
$615.00
Annual Deductible
878
Drugs Covered
0
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 | Lorbrena lorlatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 2 | Methylphenidate Hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 3 | SCEMBLIX asciminib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | Nystatin | Brand | Tier 2 | $1.00 | Details |
| 5 | BOSULIF Bosutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | TABRECTA capmatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Dupixent Dupilumab | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Risperidone | Brand | Tier 4 | 0.4% coinsurance | Details |
| 9 | Nortriptyline Hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 10 | Everolimus | Brand | Tier 4 | 0.4% coinsurance | Details |
| 11 | ZEJULA niraparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | JANUVIA sitagliptin | Brand | Tier 3 | 0.2% coinsurance | Details |
| 13 | Nitroglycerin nitroglycerin | Brand | Tier 3 | 0.2% coinsurance | Details |
| 14 | PIQRAY alpelisib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Augtyro repotrectinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 17 | ISENTRESS RALTEGRAVIR | Brand | Tier 4 | 0.4% coinsurance | Details |
| 18 | Isoniazid | Brand | Tier 2 | $1.00 | Details |
| 19 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 1 | $0.00 | Details |
| 20 | Ciprofloxacin | Brand | Tier 2 | $1.00 | Details |
Showing 20 of 878 covered drugs.
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