WyoBlue Advantage Essential PPO (PPO)
$33.70 /month
Monthly Premium
$615.00
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 | GARDASIL 9 Human Papillomavirus 9-valent Vaccine, Recombinant | Brand | Tier 3 | 0.2% coinsurance | Details |
| 2 | Medroxyprogesterone Acetate | Brand | Tier 2 | $9.00 | Details |
| 3 | Buspirone Hydrochloride | Brand | Tier 2 | $9.00 | Details |
| 4 | Cobenfy xanomeline and trospium chloride | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | Everolimus | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | Diltiazem Hydrochloride | Brand | Tier 2 | $9.00 | Details |
| 7 | Ibrance palbociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Fluphenazine Hydrochloride | Brand | Tier 4 | 0.4% coinsurance | Details |
| 9 | Venlafaxine Hydrochloride | Brand | Tier 2 | $9.00 | Details |
| 10 | Methylphenidate Hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 11 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 12 | Xalkori CRIZOTINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 13 | TABRECTA capmatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Midodrine Hydrochloride midodrine hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 15 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 2 | $9.00 | Details |
| 16 | FARXIGA DAPAGLIFLOZIN | Brand | Tier 3 | 0.2% coinsurance | Details |
| 17 | Daurismo glasdegib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Cromolyn Sodium | Brand | Tier 3 | 0.2% coinsurance | Details |
| 19 | Gilotrif afatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | Leucovorin Calcium | Brand | Tier 4 | 0.4% coinsurance | 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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