NextBlue Summit PPO (PPO)
$59.70 /month
Monthly Premium
$300.00
Annual Deductible
899
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 | Gentamicin Sulfate | Brand | Tier 3 | $0.00 | Details |
| 2 | Calcipotriene | Brand | Tier 3 | $0.00 | Details |
| 3 | Cefuroxime | Brand | Tier 4 | $0.00 | Details |
| 4 | bexarotene | Brand | Tier 5 | $0.00 | Details |
| 5 | Depo-SubQ Provera medroxyprogesterone acetate | Brand | Tier 3 | $0.00 | Details |
| 6 | Spiriva Respimat tiotropium bromide inhalation spray | Brand | Tier 3 | $0.00 | Details |
| 7 | Amoxapine | Brand | Tier 3 | $0.00 | Details |
| 8 | amiloride hydrochloride | Brand | Tier 3 | $0.00 | Details |
| 9 | Ibrance palbociclib | Brand | Tier 5 | $0.00 | Details |
| 10 | PIFELTRO doravirine | Brand | Tier 5 | $0.00 | Details |
| 11 | Propranolol Hydrochloride propranolol hydrochloride | Brand | Tier 3 | $0.00 | Details |
| 12 | ISENTRESS RALTEGRAVIR | Brand | Tier 5 | $0.00 | Details |
| 13 | Isoniazid | Brand | Tier 2 | $0.00 | Details |
| 14 | Risperidone | Brand | Tier 4 | $0.00 | Details |
| 15 | REYATAZ ATAZANAVIR | Brand | Tier 5 | $0.00 | Details |
| 16 | Venlafaxine Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 17 | PredniSONE | Brand | Tier 2 | $0.00 | Details |
| 18 | Tafinlar dabrafenib | Brand | Tier 5 | $0.00 | Details |
| 19 | CALQUENCE acalabrutinib | Brand | Tier 5 | $0.00 | Details |
| 20 | Haloperidol | Brand | Tier 3 | $0.00 | Details |
Showing 20 of 899 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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