Anthem Medicare Advantage (HMO)
$80.00 /month
Monthly Premium
$200.00
Annual Deductible
974
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 | RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) | Brand | Tier 1 | $0.00 | Details |
| 2 | Everolimus | Brand | Tier 4 | 0.3% coinsurance | Details |
| 3 | Priftin rifapentine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 4 | Omeprazole | Brand | Tier 1 | $0.00 | Details |
| 5 | Diazepam | Brand | Tier 4 | 0.3% coinsurance | Details |
| 6 | PredniSONE | Brand | Tier 1 | $0.00 | Details |
| 7 | Bromocriptine mesylate | Brand | Tier 2 | $0.00 | Details |
| 8 | Fiasp insulin aspart injection | Brand | Tier 3 | 0.3% coinsurance | Details |
| 9 | Atomoxetine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 10 | FENTANYL | Brand | Tier 4 | 0.3% coinsurance | Details |
| 11 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | 0.3% coinsurance | Details |
| 12 | Cobenfy xanomeline and trospium chloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 13 | BOSULIF Bosutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 14 | Amoxicillin | Brand | Tier 2 | $0.00 | Details |
| 15 | Nortriptyline Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 16 | Vizimpro dacomitinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | Haloperidol | Brand | Tier 4 | 0.3% coinsurance | Details |
| 18 | Lenalidomide | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Ciprofloxacin in Dextrose ciprofloxacin | Brand | Tier 4 | 0.3% coinsurance | Details |
| 20 | Nystatin | Brand | Tier 2 | $0.00 | Details |
Showing 20 of 974 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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