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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H4140-016 Cross-check on Medicare.gov →

DrSelect-CFL (HMO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$0.00 Annual Deductible
1,034 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 Jardiance Empagliflozin Brand Tier 3 $0.00 Details
2 Mekinist trametinib Brand Tier 5 $0.00 Details
3 COARTEM artemether and lumefantrine Brand Tier 4 $0.00 Details
4 Venlafaxine Hydrochloride Brand Tier 1 $0.00 Details
5 Diazepam Brand Tier 2 $0.00 Details
6 Fludrocortisone Acetate FLUDROCORTISONE ACETATE Brand Tier 2 $0.00 Details
7 ZEJULA niraparib Brand Tier 5 $0.00 Details
8 Thioridazine Hydrochloride thioridazine hydrochloride Brand Tier 1 $0.00 Details
9 Loxapine Brand Tier 2 $0.00 Details
10 SCEMBLIX asciminib Brand Tier 5 $0.00 Details
11 SOMAVERT pegvisomant Brand Tier 5 $0.00 Details
12 Levothyroxine Sodium levothyroxine sodium Brand Tier 1 $0.00 Details
13 INLYTA axitinib Brand Tier 5 $0.00 Details
14 Carbidopa and levodopa Brand Tier 2 $0.00 Details
15 Hydrocortisone Brand Tier 1 $0.00 Details
16 HYDROCODONE BITARTRATE AND ACETAMINOPHEN Brand Tier 1 $0.00 Details
17 BOSULIF Bosutinib Brand Tier 5 $0.00 Details
18 Nortriptyline Hydrochloride Brand Tier 2 $0.00 Details
19 TAGRISSO osimertinib Brand Tier 5 $0.00 Details
20 Pilocarpine Hydrochloride Brand Tier 2 $0.00 Details

Showing 20 of 1,034 covered drugs.

Compare this plan against others for your medications Enter your drugs and ZIP to see personalized out-of-pocket costs.
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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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