True Blue Rx 36 (HMO)
$70.50 /month
Monthly Premium
$130.00
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 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 2 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 3 | Tiagabine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 4 | Xospata gilteritinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | Augtyro repotrectinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | COARTEM artemether and lumefantrine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 7 | Isosorbide Dinitrate | Brand | Tier 3 | $40.00 | Details |
| 8 | Daurismo glasdegib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 9 | Verzenio abemaciclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | Clozapine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 11 | Vizimpro dacomitinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 12 | ZEJULA niraparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | Amoxapine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 14 | Rufinamide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Venclexta Venetoclax | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | FARXIGA DAPAGLIFLOZIN | Brand | Tier 3 | $40.00 | Details |
| 17 | Buspirone Hydrochloride | Brand | Tier 2 | $7.00 | Details |
| 18 | Fluphenazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 19 | REYATAZ ATAZANAVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | VARIVAX Varicella Virus Vaccine Live | Brand | Tier 3 | $40.00 | 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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