DEVOTED GIVEBACK 045 FL (HMO)
$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 | Haloperidol | Brand | Tier 2 | $0.00 | Details |
| 2 | Amoxicillin | Brand | Tier 1 | $0.00 | Details |
| 3 | VALPROIC ACID | Brand | Tier 2 | $0.00 | Details |
| 4 | RETEVMO selpercatinib | Brand | Tier 5 | $0.00 | Details |
| 5 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 6 | Mekinist trametinib | Brand | Tier 5 | $0.00 | Details |
| 7 | HYDROCODONE BITARTRATE AND ACETAMINOPHEN | Brand | Tier 2 | $0.00 | Details |
| 8 | FARXIGA DAPAGLIFLOZIN | Brand | Tier 3 | $0.00 | Details |
| 9 | Tacrolimus | Brand | Tier 2 | $0.00 | Details |
| 10 | ISENTRESS RALTEGRAVIR | Brand | Tier 4 | $0.00 | Details |
| 11 | Cromolyn Sodium | Brand | Tier 2 | $0.00 | Details |
| 12 | Everolimus | Brand | Tier 5 | $0.00 | Details |
| 13 | Probenecid | Brand | Tier 2 | $0.00 | Details |
| 14 | Priftin rifapentine | Brand | Tier 4 | $0.00 | Details |
| 15 | PODOFILOX | Brand | Tier 2 | $0.00 | Details |
| 16 | Pilocarpine Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 17 | Metoclopramide | Brand | Tier 1 | $0.00 | Details |
| 18 | Potassium Chloride potassium chloride | Brand | Tier 1 | $0.00 | Details |
| 19 | Trifluoperazine Hydrochloride trifluoperazine hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 20 | Haloperidol | Brand | Tier 2 | $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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