HumanaChoice H7617-004 (PPO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$250.00
Annual Deductible
976
Drugs Covered
2
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 | Carbidopa and levodopa | Brand | Tier 2 | $0.00 | Details |
| 2 | Rufinamide | Brand | Tier 4 | $0.00 | Details |
| 3 | Diltiazem Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 4 | Xalkori CRIZOTINIB | Brand | Tier 5 | $0.00 | Details |
| 5 | Diazepam | Brand | Tier 3 | $0.00 | Details |
| 6 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 4 | $0.00 | Details |
| 7 | Risperidone | Brand | Tier 5 | $0.00 | Details |
| 8 | Trifluoperazine Hydrochloride | Brand | Tier 3 | $0.00 | Details |
| 9 | Bromocriptine mesylate | Brand | Tier 4 | $0.00 | Details |
| 10 | GARDASIL 9 Human Papillomavirus 9-valent Vaccine, Recombinant | Brand | Tier 1 | $0.00 | Details |
| 11 | Augtyro repotrectinib | Brand | Tier 5 | $0.00 | Details |
| 12 | Cobenfy xanomeline and trospium chloride | Brand | Tier 4 | $0.00 | Details |
| 13 | Metoclopramide | Brand | Tier 1 | $0.00 | Details |
| 14 | Leucovorin Calcium | Brand | Tier 4 | $0.00 | Details |
| 15 | COARTEM artemether and lumefantrine | Brand | Tier 4 | $0.00 | Details |
| 16 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 17 | FARXIGA DAPAGLIFLOZIN | Brand | Tier 3 | $0.00 | Details |
| 18 | TAGRISSO osimertinib | Brand | Tier 5 | $0.00 | Details |
| 19 | Daurismo glasdegib | Brand | Tier 5 | $0.00 | Details |
| 20 | Gilotrif afatinib | Brand | Tier 5 | $0.00 | Details |
Showing 20 of 976 covered drugs.
States Served (2)
This plan is available to Medicare beneficiaries in the following states.
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