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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H1619-001 Cross-check on Medicare.gov →

Jefferson Health Plans Flex (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$0.00 Annual Deductible
976 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 Isosorbide Dinitrate Brand Tier 3 $0.00 Details
2 Enoxaparin Sodium Enoxaparin sodium Brand Tier 4 $0.00 Details
3 Gilotrif afatinib Brand Tier 5 $0.00 Details
4 Potassium Chloride Brand Tier 2 $0.00 Details
5 Ampicillin and Sulbactam Brand Tier 4 $0.00 Details
6 HERNEXEOS zongertinib Brand Tier 5 $0.00 Details
7 Bupropion Hydrochloride SR SR bupropion hydrochloride Brand Tier 2 $0.00 Details
8 WELIREG belzutifan Brand Tier 5 $0.00 Details
9 ELIQUIS apixaban Brand Tier 3 $0.00 Details
10 Mekinist trametinib Brand Tier 5 $0.00 Details
11 Pioglitazone Brand Tier 1 $0.00 Details
12 FARXIGA DAPAGLIFLOZIN Brand Tier 3 $0.00 Details
13 Amoxicillin Brand Tier 1 $0.00 Details
14 Amoxicillin Brand Tier 1 $0.00 Details
15 Diazepam Brand Tier 2 $0.00 Details
16 Risperidone Brand Tier 4 $0.00 Details
17 VALPROIC ACID Brand Tier 3 $0.00 Details
18 Fetzima LEVOMILNACIPRAN HYDROCHLORIDE Brand Tier 4 $0.00 Details
19 Efavirenz, Emtricitabine and Tenofovir Disoproxil Fumarate Brand Tier 3 $0.00 Details
20 Medroxyprogesterone Acetate Brand Tier 2 $0.00 Details

Showing 20 of 976 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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