PacificSource Dual Care (HMO D-SNP)
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00
Annual Deductible
1,037
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 | Carbidopa and levodopa | Brand | Tier 2 | $0.00 | Details |
| 2 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 2 | $0.00 | Details |
| 3 | Clozapine | Brand | Tier 4 | $0.00 | Details |
| 4 | Amoxicillin | Brand | Tier 2 | $0.00 | Details |
| 5 | Trifluoperazine Hydrochloride trifluoperazine hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 6 | Ciprofloxacin in Dextrose ciprofloxacin | Brand | Tier 4 | $0.00 | Details |
| 7 | Thioridazine Hydrochloride thioridazine hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 8 | Chlorhexidine Gluconate | Brand | Tier 2 | $0.00 | Details |
| 9 | Lorbrena lorlatinib | Brand | Tier 5 | $0.00 | Details |
| 10 | PIQRAY alpelisib | Brand | Tier 5 | $0.00 | Details |
| 11 | Isosorbide Dinitrate | Brand | Tier 2 | $0.00 | Details |
| 12 | Acarbose | Brand | Tier 2 | $0.00 | Details |
| 13 | Enoxaparin Sodium Enoxaparin sodium | Brand | Tier 2 | $0.00 | Details |
| 14 | Trifluoperazine Hydrochloride trifluoperazine hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 15 | Dicyclomine Dicyclomine hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 16 | Dupixent Dupilumab | Brand | Tier 5 | $0.00 | Details |
| 17 | JAYPIRCA pirtobrutinib | Brand | Tier 5 | $0.00 | Details |
| 18 | KISQALI ribociclib | Brand | Tier 5 | $0.00 | Details |
| 19 | VERQUVO vericiguat | Brand | Tier 3 | $0.00 | Details |
| 20 | Levothyroxine Sodium levothyroxine sodium | Brand | Tier 2 | $0.00 | Details |
Showing 20 of 1,037 covered drugs.
States Served (1)
This plan is available to Medicare beneficiaries in the following states.
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