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Verified against CMS.gov · on Apr 1, 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 Clozapine Brand Tier 4 See Plan Details
2 RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) Brand Tier 6 See Plan Details
3 Everolimus Brand Tier 4 See Plan Details
4 ISENTRESS RALTEGRAVIR Brand Tier 5 See Plan Details
5 Prograf Tacrolimus Brand Tier 4 See Plan Details
6 TicoVac Tick-Borne Encephalitis Vaccine Brand Tier 6 See Plan Details
7 ISENTRESS RALTEGRAVIR Brand Tier 5 See Plan Details
8 PENBRAYA meningococcal groups a, b, c, w, and y vaccine Brand Tier 6 See Plan Details
9 EVOTAZ atazanavir and cobicistat Brand Tier 5 See Plan Details
10 Ibrance palbociclib Brand Tier 5 See Plan Details
11 Cobenfy xanomeline and trospium chloride Brand Tier 5 See Plan Details
12 SOMAVERT pegvisomant Brand Tier 5 See Plan Details
13 Primaquine Phosphate Brand Tier 4 See Plan Details
14 Clarithromycin Brand Tier 3 See Plan Details
15 Diltiazem Hydrochloride Brand Tier 1 See Plan Details
16 Phenobarbital Brand Tier 2 See Plan Details
17 Dexamethasone Brand Tier 2 See Plan Details
18 Fludrocortisone Acetate FLUDROCORTISONE ACETATE Brand Tier 2 See Plan Details
19 Cobenfy xanomeline and trospium chloride Brand Tier 5 See Plan Details
20 Lorbrena lorlatinib Brand Tier 5 See Plan Details

Showing 20 of 1,022 covered drugs.

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