True Blue Rx 35PSP (HMO)
$43.90 /month
Monthly Premium
$150.00
Annual Deductible
862
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 | Venlafaxine Hydrochloride | Brand | Tier 2 | $7.00 | Details |
| 2 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 3 | Combivent Respimat ipratropium bromide and albuterol | Brand | Tier 4 | 0.3% coinsurance | Details |
| 4 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 5 | Morphine Sulfate | Brand | Tier 4 | 0.3% coinsurance | Details |
| 6 | Aptivus tipranavir | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Rufinamide | Brand | Tier 4 | 0.3% coinsurance | Details |
| 8 | Tacrolimus | Brand | Tier 4 | 0.3% coinsurance | Details |
| 9 | Priftin rifapentine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 10 | Primaquine Phosphate | Brand | Tier 4 | 0.3% coinsurance | Details |
| 11 | BCG VACCINE BACILLUS CALMETTE-GUERIN SUBSTRAIN TICE LIVE ANTIGEN | Brand | Tier 3 | $40.00 | Details |
| 12 | Nortriptyline Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 13 | Nitroglycerin nitroglycerin | Brand | Tier 2 | $7.00 | Details |
| 14 | PIQRAY alpelisib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Loxapine | Brand | Tier 3 | $40.00 | Details |
| 16 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 17 | Haloperidol | Brand | Tier 2 | $7.00 | Details |
| 18 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 19 | Paxlovid nirmatrelvir and ritonavir | Brand | Tier 3 | $40.00 | Details |
| 20 | Venlafaxine Hydrochloride | Brand | Tier 2 | $7.00 | Details |
Showing 20 of 862 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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