Imperial Dynamic Plan (HMO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$0.00
Annual Deductible
930
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 | Fiasp insulin aspart injection | Brand | Tier 3 | $0.00 | Details |
| 2 | Chlorhexidine Gluconate | Brand | Tier 1 | $0.00 | Details |
| 3 | Cefuroxime | Brand | Tier 2 | $0.00 | Details |
| 4 | Cobenfy xanomeline and trospium chloride | Brand | Tier 5 | $0.00 | Details |
| 5 | Amoxapine | Brand | Tier 2 | $0.00 | Details |
| 6 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 7 | Ibrance palbociclib | Brand | Tier 5 | $0.00 | Details |
| 8 | NOVOLOG insulin aspart | Brand | Tier 3 | $0.00 | Details |
| 9 | Tafinlar dabrafenib | Brand | Tier 5 | $0.00 | Details |
| 10 | Lenalidomide | Brand | Tier 5 | $0.00 | Details |
| 11 | Gentamicin Sulfate | Brand | Tier 2 | $0.00 | Details |
| 12 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | $0.00 | Details |
| 13 | Xtandi enzalutamide | Brand | Tier 5 | $0.00 | Details |
| 14 | Efavirenz, Emtricitabine and Tenofovir Disoproxil Fumarate | Brand | Tier 2 | $0.00 | Details |
| 15 | KISQALI ribociclib | Brand | Tier 5 | $0.00 | Details |
| 16 | Verzenio abemaciclib | Brand | Tier 5 | $0.00 | Details |
| 17 | Atomoxetine | Brand | Tier 2 | $0.00 | Details |
| 18 | Fetzima LEVOMILNACIPRAN HYDROCHLORIDE | Brand | Tier 4 | $0.00 | Details |
| 19 | Mifepristone | Brand | Tier 5 | $0.00 | Details |
| 20 | GARDASIL 9 Human Papillomavirus 9-valent Vaccine, Recombinant | Brand | Tier 3 | $0.00 | Details |
Showing 20 of 930 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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