Medica Advantage Solution H8889-003 (PPO)
$107.20 /month
Monthly Premium
$125.00
Annual Deductible
981
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 | Fluphenazine Hydrochloride | Brand | Tier 4 | $0.00 | Details |
| 2 | Ciprofloxacin in Dextrose ciprofloxacin | Brand | Tier 4 | $0.00 | Details |
| 3 | Dicyclomine Dicyclomine hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 4 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 5 | Primaquine Phosphate | Brand | Tier 4 | $0.00 | Details |
| 6 | Erlotinib | Brand | Tier 5 | $0.00 | Details |
| 7 | Clozapine | Brand | Tier 4 | $0.00 | Details |
| 8 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 9 | TicoVac Tick-Borne Encephalitis Vaccine | Brand | Tier 3 | $0.00 | Details |
| 10 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 1 | $0.00 | Details |
| 11 | RETEVMO selpercatinib | Brand | Tier 5 | $0.00 | Details |
| 12 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 13 | Buspirone Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 14 | Xtandi enzalutamide | Brand | Tier 5 | $0.00 | Details |
| 15 | Midodrine Hydrochloride midodrine hydrochloride | Brand | Tier 3 | $0.00 | Details |
| 16 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 3 | $0.00 | Details |
| 17 | Cyclosporine Modified Modified Cyclosporine | Brand | Tier 3 | $0.00 | Details |
| 18 | Potassium Chloride potassium chloride | Brand | Tier 2 | $0.00 | Details |
| 19 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 20 | PIFELTRO doravirine | Brand | Tier 5 | $0.00 | Details |
Showing 20 of 981 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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