Freedom Platinum Rewards Plan Rx (HMO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$0.00
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 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 3 | $50.00 | Details |
| 2 | Clozapine | Brand | Tier 3 | $50.00 | Details |
| 3 | Metoprolol Tartrate metoprolol tartrate | Brand | Tier 1 | $0.00 | Details |
| 4 | Balsalazide Disodium | Brand | Tier 2 | $10.00 | Details |
| 5 | Amoxicillin | Brand | Tier 1 | $0.00 | Details |
| 6 | Pilocarpine Hydrochloride | Brand | Tier 3 | $50.00 | Details |
| 7 | Estradiol | Brand | Tier 1 | $0.00 | Details |
| 8 | Paxlovid nirmatrelvir and ritonavir | Brand | Tier 1 | $0.00 | Details |
| 9 | Medroxyprogesterone Acetate | Brand | Tier 1 | $0.00 | Details |
| 10 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 11 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 12 | Lupron Depot leuprolide acetate | Brand | Tier 4 | 0.3% coinsurance | Details |
| 13 | FENTANYL | Brand | Tier 3 | $50.00 | Details |
| 14 | Clozapine | Brand | Tier 2 | $10.00 | Details |
| 15 | Valsartan valsartan | Brand | Tier 1 | $0.00 | Details |
| 16 | Phenobarbital | Brand | Tier 2 | $10.00 | Details |
| 17 | Venclexta Venetoclax | Brand | Tier 2 | $10.00 | Details |
| 18 | RETEVMO selpercatinib | Brand | Tier 4 | 0.3% coinsurance | Details |
| 19 | NITROGLYCERIN nitroglycerin | Brand | Tier 2 | $10.00 | Details |
| 20 | Hydrochlorothiazide | 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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