DEVOTED CHOICE GIVEBACK 009 NC (PPO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$605.00
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 | Venclexta Venetoclax | Brand | Tier 5 | $0.00 | Details |
| 2 | Fluphenazine Hydrochloride | Brand | Tier 4 | $0.00 | Details |
| 3 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 3 | $0.00 | Details |
| 4 | Nefazodone Hydrochloride | Brand | Tier 4 | $0.00 | Details |
| 5 | SOMAVERT pegvisomant | Brand | Tier 5 | $0.00 | Details |
| 6 | Cromolyn Sodium | Brand | Tier 3 | $0.00 | Details |
| 7 | Probenecid | Brand | Tier 3 | $0.00 | Details |
| 8 | VARIVAX Varicella Virus Vaccine Live | Brand | Tier 1 | $0.00 | Details |
| 9 | Diltiazem Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 10 | Dexamethasone | Brand | Tier 3 | $0.00 | Details |
| 11 | CALQUENCE acalabrutinib | Brand | Tier 5 | $0.00 | Details |
| 12 | HYDROCODONE BITARTRATE AND ACETAMINOPHEN | Brand | Tier 3 | $0.00 | Details |
| 13 | Dupixent Dupilumab | Brand | Tier 5 | $0.00 | Details |
| 14 | Isosorbide Dinitrate | Brand | Tier 3 | $0.00 | Details |
| 15 | Talzenna talazoparib | Brand | Tier 5 | $0.00 | Details |
| 16 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 4 | $0.00 | Details |
| 17 | Hydrocortisone | Brand | Tier 2 | $0.00 | Details |
| 18 | JANUVIA sitagliptin | Brand | Tier 3 | $0.00 | Details |
| 19 | MERCAPTOPURINE | Brand | Tier 5 | $0.00 | Details |
| 20 | Pioglitazone | 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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