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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H5522-029 Cross-check on Medicare.gov →

Aetna Medicare PinnacleHealth Prime (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$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 Linzess linaclotide Brand Tier 3 0.2% coinsurance Details
2 Lenalidomide Brand Tier 5 0.3% coinsurance Details
3 PIQRAY alpelisib Brand Tier 5 0.3% coinsurance Details
4 VALPROIC ACID Brand Tier 2 $0.00 Details
5 Cilostazol Brand Tier 2 $0.00 Details
6 Thioridazine Hydrochloride thioridazine hydrochloride Brand Tier 3 0.2% coinsurance Details
7 Nystatin Brand Tier 2 $0.00 Details
8 RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) Brand Tier 1 $0.00 Details
9 ISENTRESS RALTEGRAVIR Brand Tier 5 0.3% coinsurance Details
10 Ciprofloxacin Brand Tier 2 $0.00 Details
11 Doxepin Hydrochloride doxepin hydrochloride Brand Tier 4 0.3% coinsurance Details
12 Chlorpromazine Hydrochloride Brand Tier 4 0.3% coinsurance Details
13 Dexamethasone Brand Tier 4 0.3% coinsurance Details
14 Haloperidol Brand Tier 2 $0.00 Details
15 Ciprofloxacin Brand Tier 2 $0.00 Details
16 Rufinamide Brand Tier 5 0.3% coinsurance Details
17 BOSULIF Bosutinib Brand Tier 5 0.3% coinsurance Details
18 SCEMBLIX asciminib Brand Tier 5 0.3% coinsurance Details
19 Teflaro ceftaroline fosamil Brand Tier 5 0.3% coinsurance Details
20 PIQRAY alpelisib Brand Tier 5 0.3% coinsurance Details

Showing 20 of 1,055 covered drugs.

Compare this plan against others for your medications Enter your drugs and ZIP to see personalized out-of-pocket costs.
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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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