Champion Plus (HMO C-SNP)
$12.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00
Annual Deductible
930
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 | Ibrance palbociclib | Brand | Tier 5 | $0.00 | Details |
| 2 | Omeprazole | Brand | Tier 1 | $0.00 | Details |
| 3 | Dupixent Dupilumab | Brand | Tier 5 | $0.00 | Details |
| 4 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 5 | Chlorpromazine Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 6 | Paxlovid nirmatrelvir and ritonavir | Brand | Tier 2 | $0.00 | Details |
| 7 | Haloperidol | Brand | Tier 2 | $0.00 | Details |
| 8 | Mekinist trametinib | Brand | Tier 5 | $0.00 | Details |
| 9 | Cyclosporine | Brand | Tier 2 | $0.00 | Details |
| 10 | Risperidone | Brand | Tier 2 | $0.00 | Details |
| 11 | Clonidine Hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 12 | Erlotinib | Brand | Tier 5 | $0.00 | Details |
| 13 | Perphenazine perphenazine | Brand | Tier 2 | $0.00 | Details |
| 14 | Isosorbide Dinitrate | Brand | Tier 2 | $0.00 | Details |
| 15 | Risperidone | Brand | Tier 5 | $0.00 | Details |
| 16 | Lynparza olaparib | Brand | Tier 5 | $0.00 | Details |
| 17 | NITROGLYCERIN nitroglycerin | Brand | Tier 2 | $0.00 | Details |
| 18 | Bupropion Hydrochloride SR SR bupropion hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 19 | Dupixent Dupilumab | Brand | Tier 5 | $0.00 | Details |
| 20 | SOMAVERT pegvisomant | Brand | Tier 5 | $0.00 | Details |
Showing 20 of 930 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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