Aetna Medicare Elite Extra (PPO)
$44.00 /month
Monthly Premium
$615.00
Annual Deductible
1,055
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 | Dicyclomine Dicyclomine hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 2 | RETEVMO selpercatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Aprepitant aprepitant | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | TABRECTA capmatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 5 | Amoxapine | Brand | Tier 3 | 0.2% coinsurance | Details |
| 6 | PedvaxHIB Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate) | Brand | Tier 1 | $0.00 | Details |
| 7 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 8 | Ibrance palbociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 9 | Fluvoxamine maleate | Brand | Tier 2 | $0.00 | Details |
| 10 | Isosorbide Dinitrate | Brand | Tier 2 | $0.00 | Details |
| 11 | Nitroglycerin nitroglycerin | Brand | Tier 2 | $0.00 | Details |
| 12 | Isoniazid | Brand | Tier 1 | $0.00 | Details |
| 13 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 14 | Nefazodone Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 15 | RETEVMO selpercatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 16 | Talzenna talazoparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | HYDROCODONE BITARTRATE AND ACETAMINOPHEN | Brand | Tier 3 | 0.2% coinsurance | Details |
| 18 | JAYPIRCA pirtobrutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | TicoVac Tick-Borne Encephalitis Vaccine | Brand | Tier 1 | $0.00 | Details |
| 20 | ISENTRESS RALTEGRAVIR | Brand | Tier 5 | 0.3% coinsurance | Details |
Showing 20 of 1,055 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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