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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H1619-003 Cross-check on Medicare.gov →

Jefferson Health Plans Flex Pro (PPO)

Plan Year 2026
$18.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$0.00 Annual Deductible
1,019 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 Emtricitabine and Tenofovir Disoproxil Fumarate Brand Tier 4 $0.00 Details
2 ProQuad Measles, Mumps, Rubella and Varicella Virus Vaccine Live Brand Tier 1 $0.00 Details
3 Everolimus Brand Tier 5 $0.00 Details
4 Priftin rifapentine Brand Tier 4 $0.00 Details
5 ISENTRESS RALTEGRAVIR Brand Tier 5 $0.00 Details
6 Doxepin Hydrochloride doxepin hydrochloride Brand Tier 2 $0.00 Details
7 Ipratropium Bromide Brand Tier 2 $0.00 Details
8 Vizimpro dacomitinib Brand Tier 5 $0.00 Details
9 Potassium Chloride Brand Tier 2 $0.00 Details
10 RETEVMO selpercatinib Brand Tier 5 $0.00 Details
11 amiloride hydrochloride Brand Tier 2 $0.00 Details
12 PIFELTRO doravirine Brand Tier 5 $0.00 Details
13 Haloperidol Brand Tier 2 $0.00 Details
14 Mekinist trametinib Brand Tier 5 $0.00 Details
15 RYDAPT Brand Tier 5 $0.00 Details
16 Clonidine Hydrochloride Brand Tier 1 $0.00 Details
17 bexarotene Brand Tier 5 $0.00 Details
18 Daurismo glasdegib Brand Tier 5 $0.00 Details
19 Clozapine Brand Tier 4 $0.00 Details
20 Amoxicillin Brand Tier 1 $0.00 Details

Showing 20 of 1,019 covered drugs.

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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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