Network Health PremierRx (PPO)
$92.80 /month
Monthly Premium
$340.00
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 | Midodrine Hydrochloride midodrine hydrochloride | Brand | Tier 2 | $8.00 | Details |
| 2 | HYDROCODONE BITARTRATE AND ACETAMINOPHEN | Brand | Tier 3 | 0.2% coinsurance | Details |
| 3 | Atomoxetine | Brand | Tier 4 | 0.3% coinsurance | Details |
| 4 | Morphine Sulfate | Brand | Tier 3 | 0.2% coinsurance | Details |
| 5 | WELIREG belzutifan | Brand | Tier 5 | 0.3% coinsurance | Details |
| 6 | Morphine Sulfate | Brand | Tier 3 | 0.2% coinsurance | Details |
| 7 | ZEJULA niraparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 8 | Linzess linaclotide | Brand | Tier 3 | 0.2% coinsurance | Details |
| 9 | Xalkori CRIZOTINIB | Brand | Tier 5 | 0.3% coinsurance | Details |
| 10 | Daurismo glasdegib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 11 | Valsartan valsartan | Brand | Tier 1 | $0.00 | Details |
| 12 | Diazepam | Brand | Tier 3 | 0.2% coinsurance | Details |
| 13 | Ciprofloxacin | Brand | Tier 2 | $8.00 | Details |
| 14 | Nefazodone Hydrochloride | Brand | Tier 3 | 0.2% coinsurance | Details |
| 15 | Calcipotriene | Brand | Tier 3 | 0.2% coinsurance | Details |
| 16 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 1 | $0.00 | Details |
| 17 | VAQTA hepatitis A vaccine, inactivated | Brand | Tier 3 | 0.2% coinsurance | Details |
| 18 | Talzenna talazoparib | Brand | Tier 5 | 0.3% coinsurance | Details |
| 19 | Digoxin | Brand | Tier 2 | $8.00 | Details |
| 20 | Xalkori CRIZOTINIB | Brand | Tier 5 | 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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