DEVOTED CHOICE GIVEBACK 001 TX (PPO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$605.00
Annual Deductible
995
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 | Dicyclomine Dicyclomine hydrochloride | Brand | Tier 3 | $0.00 | Details |
| 2 | Fluphenazine Hydrochloride | Brand | Tier 4 | $0.00 | Details |
| 3 | Verzenio abemaciclib | Brand | Tier 5 | $0.00 | Details |
| 4 | Mekinist trametinib | Brand | Tier 5 | $0.00 | Details |
| 5 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 6 | Talzenna talazoparib | Brand | Tier 5 | $0.00 | Details |
| 7 | Dexamethasone | Brand | Tier 3 | $0.00 | Details |
| 8 | Gilotrif afatinib | Brand | Tier 5 | $0.00 | Details |
| 9 | Venlafaxine Hydrochloride | Brand | Tier 3 | $0.00 | Details |
| 10 | Haloperidol | Brand | Tier 3 | $0.00 | Details |
| 11 | Amoxicillin | Brand | Tier 1 | $0.00 | Details |
| 12 | VALPROIC ACID | Brand | Tier 3 | $0.00 | Details |
| 13 | RETEVMO selpercatinib | Brand | Tier 5 | $0.00 | Details |
| 14 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 15 | Mekinist trametinib | Brand | Tier 5 | $0.00 | Details |
| 16 | HYDROCODONE BITARTRATE AND ACETAMINOPHEN | Brand | Tier 3 | $0.00 | Details |
| 17 | FARXIGA DAPAGLIFLOZIN | Brand | Tier 3 | $0.00 | Details |
| 18 | Tacrolimus | Brand | Tier 4 | $0.00 | Details |
| 19 | ISENTRESS RALTEGRAVIR | Brand | Tier 4 | $0.00 | Details |
| 20 | Cromolyn Sodium | Brand | Tier 3 | $0.00 | Details |
Showing 20 of 995 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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