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Verified against CMS.gov · on April 2026 Plan ID: H4704-001 Cross-check on Medicare.gov →

Anthem Dual Advantage (PPO D-SNP)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00 Annual Deductible
1,022 Drugs Covered
0 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 Lorbrena lorlatinib Brand Tier 5 See Plan Details
2 PedvaxHIB Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate) Brand Tier 6 See Plan Details
3 Baclofen baclofen Brand Tier 2 See Plan Details
4 Omeprazole Brand Tier 6 See Plan Details
5 Diazepam Brand Tier 2 See Plan Details
6 Loxapine Brand Tier 4 See Plan Details
7 Metoclopramide Brand Tier 1 See Plan Details
8 Depo-SubQ Provera medroxyprogesterone acetate Brand Tier 3 See Plan Details
9 Buprenorphine Brand Tier 2 See Plan Details
10 Estradiol Brand Tier 1 See Plan Details
11 Talzenna talazoparib Brand Tier 5 See Plan Details
12 Midodrine Hydrochloride midodrine hydrochloride Brand Tier 4 See Plan Details
13 Aptivus tipranavir Brand Tier 5 See Plan Details
14 RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) Brand Tier 6 See Plan Details
15 Enoxaparin Sodium Enoxaparin sodium Brand Tier 4 See Plan Details
16 Emtricitabine and Tenofovir Disoproxil Fumarate Brand Tier 4 See Plan Details
17 Balsalazide Disodium Brand Tier 4 See Plan Details
18 BOSULIF Bosutinib Brand Tier 5 See Plan Details
19 Diltiazem Hydrochloride Brand Tier 1 See Plan Details
20 Nortriptyline Hydrochloride Brand Tier 4 See Plan Details

Showing 20 of 1,022 covered drugs.

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