DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
$36.20 /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 | CALQUENCE acalabrutinib | Brand | Tier 5 | $0.00 | Details |
| 2 | HYDROCODONE BITARTRATE AND ACETAMINOPHEN | Brand | Tier 3 | $0.00 | Details |
| 3 | Dupixent Dupilumab | Brand | Tier 5 | $0.00 | Details |
| 4 | Isosorbide Dinitrate | Brand | Tier 3 | $0.00 | Details |
| 5 | Talzenna talazoparib | Brand | Tier 5 | $0.00 | Details |
| 6 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 4 | $0.00 | Details |
| 7 | Hydrocortisone | Brand | Tier 2 | $0.00 | Details |
| 8 | JANUVIA sitagliptin | Brand | Tier 3 | $0.00 | Details |
| 9 | MERCAPTOPURINE | Brand | Tier 5 | $0.00 | Details |
| 10 | Pioglitazone | Brand | Tier 6 | $0.00 | Details |
| 11 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 12 | Amoxicillin and Clavulanate Potassium | Brand | Tier 3 | $0.00 | Details |
| 13 | Dextrose and Sodium Chloride | Brand | Tier 3 | $0.00 | Details |
| 14 | WINREVAIR SOTATERCEPT-CSRK | Brand | Tier 5 | $0.00 | Details |
| 15 | Ibrance palbociclib | Brand | Tier 5 | $0.00 | Details |
| 16 | Metoclopramide | Brand | Tier 1 | $0.00 | Details |
| 17 | Cabergoline | Brand | Tier 3 | $0.00 | Details |
| 18 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 19 | TRUQAP capivasertib | Brand | Tier 5 | $0.00 | Details |
| 20 | Norvir Ritonavir | Brand | Tier 4 | $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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