Prescription Blue Premium (PDP)
$106.70 /month
Monthly Premium
$0.00
Annual Deductible
899
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 | RETEVMO selpercatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 2 | Warfarin Sodium | Brand | Tier 1 | $1.00 | Details |
| 3 | Pioglitazone | Brand | Tier 1 | $1.00 | Details |
| 4 | Rufinamide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | Nystatin | Brand | Tier 2 | $5.00 | Details |
| 6 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 7 | Diltiazem Hydrochloride | Brand | Tier 2 | $5.00 | Details |
| 8 | PIQRAY alpelisib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 9 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | Fluvoxamine maleate | Brand | Tier 3 | 0.2% coinsurance | Details |
| 11 | NOVOLOG insulin aspart | Brand | Tier 3 | 0.2% coinsurance | Details |
| 12 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | 0.3% coinsurance | Details |
| 13 | Isosorbide Dinitrate | Brand | Tier 3 | 0.2% coinsurance | Details |
| 14 | Lenalidomide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Neomycin Sulfate | Brand | Tier 2 | $5.00 | Details |
| 16 | Dextrose and Sodium Chloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 17 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 2 | $5.00 | Details |
| 18 | Prochlorperazine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 19 | Venclexta Venetoclax | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | FARXIGA DAPAGLIFLOZIN | Brand | Tier 3 | 0.2% coinsurance | Details |
Showing 20 of 899 covered drugs.
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