DEVOTED GIVEBACK 009 VA (HMO)
$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 | Dicloxacillin Sodium | Brand | Tier 3 | $0.00 | Details |
| 2 | KOSELUGO SELUMETINIB | Brand | Tier 5 | $0.00 | Details |
| 3 | COARTEM artemether and lumefantrine | Brand | Tier 4 | $0.00 | Details |
| 4 | Abrysvo Respiratory Syncytial Virus Vaccine | Brand | Tier 1 | $0.00 | Details |
| 5 | Medroxyprogesterone Acetate | Brand | Tier 1 | $0.00 | Details |
| 6 | Amoxicillin | Brand | Tier 1 | $0.00 | Details |
| 7 | Clozapine | Brand | Tier 4 | $0.00 | Details |
| 8 | Dexamethasone | Brand | Tier 3 | $0.00 | Details |
| 9 | Phenobarbital | Brand | Tier 3 | $0.00 | Details |
| 10 | Buspirone Hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 11 | RETEVMO selpercatinib | Brand | Tier 5 | $0.00 | Details |
| 12 | Pioglitazone | Brand | Tier 1 | $0.00 | Details |
| 13 | Xtandi enzalutamide | Brand | Tier 5 | $0.00 | Details |
| 14 | Aptivus tipranavir | Brand | Tier 5 | $0.00 | Details |
| 15 | Amoxicillin | Brand | Tier 1 | $0.00 | Details |
| 16 | Cyclosporine | Brand | Tier 4 | $0.00 | Details |
| 17 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 1 | $0.00 | Details |
| 18 | Dexamethasone | Brand | Tier 3 | $0.00 | Details |
| 19 | ELIQUIS 30-Day Starter Pack 30-Day Starter Pack apixaban | 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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