Advantage Plus by Ultimate (Partial) (HMO D-SNP)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00
Annual Deductible
962
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 | Cyclosporine Modified Modified Cyclosporine | Brand | Tier 4 | $0.00 | Details |
| 3 | Nystatin | Brand | Tier 2 | $0.00 | Details |
| 4 | Dupixent Dupilumab | Brand | Tier 5 | $0.00 | Details |
| 5 | SCEMBLIX asciminib | Brand | Tier 5 | $0.00 | Details |
| 6 | Cefuroxime | Brand | Tier 4 | $0.00 | Details |
| 7 | Dexamethasone | Brand | Tier 2 | $0.00 | Details |
| 8 | GARDASIL 9 Human Papillomavirus 9-valent Vaccine, Recombinant | Brand | Tier 1 | $0.00 | Details |
| 9 | Ibrance palbociclib | Brand | Tier 5 | $0.00 | Details |
| 10 | Diazepam | Brand | Tier 2 | $0.00 | Details |
| 11 | Venclexta Venetoclax | Brand | Tier 4 | $0.00 | Details |
| 12 | Valsartan valsartan | Brand | Tier 2 | $0.00 | Details |
| 13 | Haloperidol | Brand | Tier 2 | $0.00 | Details |
| 14 | Atomoxetine | Brand | Tier 4 | $0.00 | Details |
| 15 | Tacrolimus | Brand | Tier 4 | $0.00 | Details |
| 16 | Fiasp insulin aspart injection | Brand | Tier 3 | $0.00 | Details |
| 17 | TRUQAP capivasertib | Brand | Tier 5 | $0.00 | Details |
| 18 | Lorbrena lorlatinib | Brand | Tier 5 | $0.00 | Details |
| 19 | TRUQAP capivasertib | Brand | Tier 5 | $0.00 | Details |
| 20 | Risperidone | Brand | Tier 5 | $0.00 | Details |
Showing 20 of 962 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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