PacificSource Medicare Explorer Rx 4 (PPO)
$88.70 /month
Monthly Premium
$499.00
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 | Danazol | Brand | Tier 2 | $0.00 | Details |
| 2 | Talzenna talazoparib | Brand | Tier 5 | $0.00 | Details |
| 3 | Venlafaxine Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 4 | Amoxicillin | Brand | Tier 2 | $0.00 | Details |
| 5 | Budesonide | Brand | Tier 2 | $0.00 | Details |
| 6 | Diazepam | Brand | Tier 2 | $0.00 | Details |
| 7 | TRUQAP capivasertib | Brand | Tier 5 | $0.00 | Details |
| 8 | Pilocarpine Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 9 | Buspirone Hydrochloride | Brand | Tier 1 | $0.00 | Details |
| 10 | HERNEXEOS zongertinib | Brand | Tier 5 | $0.00 | Details |
| 11 | TESTOSTERONE ENANTHATE | Brand | Tier 2 | $0.00 | Details |
| 12 | Augtyro repotrectinib | Brand | Tier 5 | $0.00 | Details |
| 13 | Warfarin Sodium | Brand | Tier 1 | $0.00 | Details |
| 14 | Emtricitabine, Rilpivirine, Tenofovir Disoproxil Fumarate | Brand | Tier 5 | $0.00 | Details |
| 15 | Perphenazine perphenazine | Brand | Tier 2 | $0.00 | Details |
| 16 | Norvir Ritonavir | Brand | Tier 4 | $0.00 | Details |
| 17 | Nortriptyline Hydrochloride | Brand | Tier 2 | $0.00 | Details |
| 18 | Leucovorin Calcium | Brand | Tier 2 | $0.00 | Details |
| 19 | TicoVac Tick-Borne Encephalitis Vaccine | Brand | Tier 3 | $0.00 | Details |
| 20 | Methylphenidate Hydrochloride | 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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