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Verified against CMS.gov · on July 2026 Plan ID: H3655-045 Cross-check on Medicare.gov →

Anthem Medicare Advantage (HMO-POS)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$275.00 Annual Deductible
1,022 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 Scopolamine scopolamine Brand Tier 4 0.3% coinsurance Details
2 RETEVMO selpercatinib Brand Tier 5 0.3% coinsurance Details
3 Diazepam Intensol Brand Tier 2 $0.00 Details
4 Haloperidol Brand Tier 2 $0.00 Details
5 Atomoxetine Brand Tier 4 0.3% coinsurance Details
6 Amoxapine Brand Tier 2 $0.00 Details
7 Carbidopa and levodopa Brand Tier 2 $0.00 Details
8 TAGRISSO osimertinib Brand Tier 5 0.3% coinsurance Details
9 Levothyroxine Sodium levothyroxine sodium Brand Tier 6 $0.00 Details
10 Amoxapine Brand Tier 2 $0.00 Details
11 Fetzima LEVOMILNACIPRAN HYDROCHLORIDE Brand Tier 4 0.3% coinsurance Details
12 Vizimpro dacomitinib Brand Tier 5 0.3% coinsurance Details
13 JANUVIA sitagliptin Brand Tier 3 0.3% coinsurance Details
14 Potassium Chloride potassium chloride Brand Tier 2 $0.00 Details
15 Xospata gilteritinib Brand Tier 5 0.3% coinsurance Details
16 Clozapine Brand Tier 4 0.3% coinsurance Details
17 Teflaro ceftaroline fosamil Brand Tier 5 0.3% coinsurance Details
18 ENTRESTO Sacubitril and Valsartan Brand Tier 3 0.3% coinsurance Details
19 FARXIGA DAPAGLIFLOZIN Brand Tier 3 0.3% coinsurance Details
20 RotaTeq Rotavirus Vaccine, Live, Oral, Pentavalent Brand Tier 6 $0.00 Details

Showing 20 of 1,022 covered drugs.

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States Served (1)

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

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