Health First Value H1099-006 (HMO)
$15.00 /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 | Clozapine | Brand | Tier 2 | $5.00 | Details |
| 2 | Gentamicin Sulfate | Brand | Tier 2 | $5.00 | Details |
| 3 | M-M-R II measles, mumps, and rubella virus vaccine live | Brand | Tier 3 | $42.00 | Details |
| 4 | Potassium Chloride potassium chloride | Brand | Tier 1 | $0.00 | Details |
| 5 | Clozapine | Brand | Tier 2 | $5.00 | Details |
| 6 | Lupron Depot leuprolide acetate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 7 | Dicloxacillin Sodium | Brand | Tier 2 | $5.00 | Details |
| 8 | Paxlovid nirmatrelvir and ritonavir | Brand | Tier 1 | $0.00 | Details |
| 9 | Baclofen | Brand | Tier 2 | $5.00 | Details |
| 10 | Diazepam | Brand | Tier 2 | $5.00 | Details |
| 11 | ELIQUIS 30-Day Starter Pack 30-Day Starter Pack apixaban | Brand | Tier 3 | $42.00 | Details |
| 12 | PredniSONE | Brand | Tier 1 | $0.00 | Details |
| 13 | Tiagabine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 14 | JAYPIRCA pirtobrutinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 15 | Paxlovid nirmatrelvir and ritonavir | Brand | Tier 1 | $0.00 | Details |
| 16 | TABRECTA capmatinib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | Amoxicillin | Brand | Tier 1 | $0.00 | Details |
| 18 | Danazol | Brand | Tier 4 | 0.3% coinsurance | Details |
| 19 | Talzenna talazoparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 20 | JANUVIA sitagliptin | Brand | Tier 3 | $42.00 | Details |
Showing 20 of 1,034 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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