DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP)
$43.00 /month
Monthly Premium
$615.00
Annual Deductible
964
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 | Fluphenazine Hydrochloride | Brand | Tier 4 | $0.00 | Details |
| 2 | PIQRAY alpelisib | Brand | Tier 5 | $0.00 | Details |
| 3 | VALPROIC ACID | Brand | Tier 3 | $0.00 | Details |
| 4 | JAYPIRCA pirtobrutinib | Brand | Tier 5 | $0.00 | Details |
| 5 | Clozapine | Brand | Tier 4 | $0.00 | Details |
| 6 | TRETINOIN tretinoin | Brand | Tier 4 | $0.00 | Details |
| 7 | Verzenio abemaciclib | Brand | Tier 5 | $0.00 | Details |
| 8 | Mekinist trametinib | Brand | Tier 5 | $0.00 | Details |
| 9 | Lynparza olaparib | Brand | Tier 5 | $0.00 | Details |
| 10 | bexarotene | Brand | Tier 5 | $0.00 | Details |
| 11 | JANUVIA sitagliptin | Brand | Tier 3 | $0.00 | Details |
| 12 | Haloperidol | Brand | Tier 3 | $0.00 | Details |
| 13 | Pilocarpine Hydrochloride | Brand | Tier 3 | $0.00 | Details |
| 14 | Ciprofloxacin | Brand | Tier 1 | $0.00 | Details |
| 15 | Metoclopramide | Brand | Tier 1 | $0.00 | Details |
| 16 | Risperidone | Brand | Tier 5 | $0.00 | Details |
| 17 | Trifluoperazine Hydrochloride trifluoperazine hydrochloride | Brand | Tier 3 | $0.00 | Details |
| 18 | KISQALI ribociclib | Brand | Tier 5 | $0.00 | Details |
| 19 | Gentamicin Sulfate | Brand | Tier 3 | $0.00 | Details |
| 20 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
Showing 20 of 964 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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