Network Health Choice (PPO)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$300.00
Annual Deductible
1,153
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 | ZEJULA niraparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 2 | Talzenna talazoparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 3 | Dupixent Dupilumab | Brand | Tier 5 | 0.3% coinsurance | Details |
| 4 | Valsartan valsartan | Brand | Tier 1 | $1.00 | Details |
| 5 | Baclofen | Brand | Tier 2 | $8.00 | Details |
| 6 | Dexamethasone | Brand | Tier 2 | $8.00 | Details |
| 7 | Heparin Sodium | Brand | Tier 3 | 0.2% coinsurance | Details |
| 8 | Diazepam | Brand | Tier 2 | $8.00 | Details |
| 9 | Fluvoxamine maleate | Brand | Tier 2 | $8.00 | Details |
| 10 | Chlorpromazine Hydrochloride | Brand | Tier 4 | 0.3% coinsurance | Details |
| 11 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $1.00 | Details |
| 12 | Phenobarbital | Brand | Tier 3 | 0.2% coinsurance | Details |
| 13 | Prochlorperazine | Brand | Tier 2 | $8.00 | Details |
| 14 | Methylphenidate Hydrochloride | Brand | Tier 2 | $8.00 | Details |
| 15 | PENBRAYA meningococcal groups a, b, c, w, and y vaccine | Brand | Tier 3 | 0.2% coinsurance | Details |
| 16 | Lupron Depot leuprolide acetate | Brand | Tier 5 | 0.3% coinsurance | Details |
| 17 | SCEMBLIX asciminib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 18 | Ibrance palbociclib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | JANUVIA sitagliptin | Brand | Tier 3 | 0.2% coinsurance | Details |
| 20 | Tacrolimus | Brand | Tier 4 | 0.3% coinsurance | Details |
Showing 20 of 1,153 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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